Provider Demographics
NPI:1124085196
Name:SASSE, CAROL ROSE (MSW, LCSW-PIP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ROSE
Last Name:SASSE
Suffix:
Gender:F
Credentials:MSW, LCSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 DOOLITTLE DR
Mailing Address - Street 2:SUITE 1M08
Mailing Address - City:ELLSWORTH AFB
Mailing Address - State:SD
Mailing Address - Zip Code:57706-4821
Mailing Address - Country:US
Mailing Address - Phone:605-385-3660
Mailing Address - Fax:605-385-2030
Practice Address - Street 1:2900 DOOLITTLE DR
Practice Address - Street 2:SUITE 1M08
Practice Address - City:ELLSWORTH AFB
Practice Address - State:SD
Practice Address - Zip Code:57706-4821
Practice Address - Country:US
Practice Address - Phone:605-385-3660
Practice Address - Fax:605-385-2030
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD20691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical