Healthcare Provider Details

I. General information

NPI: 1417622960
Provider Name (Legal Business Name): CASSIE MARIE FRYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/16/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5122 GLENCROSSING WAY
CINCINNATI OH
45238-3361
US

IV. Provider business mailing address

5122 GLENCROSSINGWAY
CINCINNATI OH
45238
US

V. Phone/Fax

Practice location:
  • Phone: 513-827-9044
  • Fax:
Mailing address:
  • Phone: 513-827-9044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number176960
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: