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General NPI Number Information
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NPI Number | 1790594257
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Entity Type | Individual
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Provider Name | KASSIE SHAWANA PATRICK
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Gender | Female
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 222 E MAIN ST STE 117
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City | BARSTOW
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State | CA
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Zip | 92311-2365
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Country | US
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Telephone | 760-255-9231
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Fax |
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Provider Business Mailing Address
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Address Line | 14248 DRY CREEK ST
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City | HESPERIA
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State | CA
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Zip | 92345-9107
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Country | US
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Telephone | 442-414-6986
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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 | ASW125235
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License Number State | CA
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