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NPI Code Detail

MEDICARE: KASANDRA AUSSEM LISW-S

MEDICARE: KASANDRA AUSSEM LISW-S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI.0700404OH

General Provider Information

NPI Number : 1942660394
Entity Type Code : Individual
Provider Name (Legal Business Name) : KASANDRA AUSSEM LISW-S
Provider Business Mailing Address
First Line : 9190 STONEGATE CIR
Second Line :
City : NORTH RIDGEVILLE
State : OH
Zip : 44039-8952
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 25111 COUNTRY CLUB BLVD STE 290
Second Line :
City : NORTH OLMSTED
State : OH
Zip : 44070-5330
Country : US
Telephone Number : 216-468-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2016
Last Update Date : 03/17/2018

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Directions to “ KASANDRA AUSSEM LISW-S” Practice Location

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