Healthcare Provider Details

I. General information

NPI: 1972094829
Provider Name (Legal Business Name): KASSANDRA R SERSIG LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2018
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 CONGRESS RD
WEST SALEM OH
44287-9526
US

IV. Provider business mailing address

6601 CONGRESS RD
WEST SALEM OH
44287-9526
US

V. Phone/Fax

Practice location:
  • Phone: 330-808-3008
  • Fax:
Mailing address:
  • Phone: 330-808-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2608221
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: