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General NPI Number Information
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NPI Number | 1932576956
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Entity Type | Individual
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Provider Name | CASSANDRA GOLDEN KRUSE LISW-S
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Gender | Female
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Dates
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Enumeration Date | 08/25/2015
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 1445 NORTH SCOTT STREET #620
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City | NAPOLEON
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State | OH
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Zip | 43545-1049
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Country | US
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Telephone | 419-592-4357
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Fax |
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Provider Business Mailing Address
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Address Line | G393 COUNTY ROAD II
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City | HAMLER
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State | OH
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Zip | 43524-8701
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Country | US
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Telephone | 419-592-4357
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LE.00021539
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.500200
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License Number State | OH
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