Provider Demographics
NPI:1194405381
Name:SIMON, KASSONDRA (LSW)
Entity type:Individual
Prefix:
First Name:KASSONDRA
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KASSONDRA
Other - Middle Name:
Other - Last Name:HORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 N. GREEN STREET
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-2421
Mailing Address - Country:US
Mailing Address - Phone:317-852-3690
Mailing Address - Fax:317-852-3766
Practice Address - Street 1:515 N. GREEN STREET
Practice Address - Street 2:SUITE 402
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-2421
Practice Address - Country:US
Practice Address - Phone:317-852-3690
Practice Address - Fax:317-852-3766
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33011309A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical