Healthcare Provider Details

I. General information

NPI: 1497451991
Provider Name (Legal Business Name): CASSIE PAIGE LONDON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5966 SCOTTSVILLE RD STE 3
BOWLING GREEN KY
42104-7908
US

IV. Provider business mailing address

710 BRISTOW RD
BOWLING GREEN KY
42101-9534
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-5104
  • Fax:
Mailing address:
  • Phone: 270-670-5098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number253893
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: