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General NPI Number Information
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NPI Number | 1215409560
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Entity Type | Individual
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Provider Name | MISTY CRASS MSW, APSW
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Gender | Female
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Dates
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Enumeration Date | 12/27/2018
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Last Update Date | 12/27/2018
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Provider Practice Location Address
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Address Line | 11345 N PORT WASHINGTON RD STE 204
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City | MEQUON
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State | WI
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Zip | 53092-3411
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Country | US
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Telephone | 262-236-5135
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Fax |
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Provider Business Mailing Address
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Address Line | 8997 HIGH LAND DR
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City | KEWASKUM
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State | WI
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Zip | 53040-9436
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Country | US
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Telephone | 651-494-2314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 131265-121
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License Number State | WI
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