Provider Demographics
NPI:1932576956
Name:KRUSE, CASSANDRA GOLDEN (LISW-S)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:GOLDEN
Last Name:KRUSE
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:MRS
Other - First Name:CASSANDRA
Other - Middle Name:JANE
Other - Last Name:MCCONN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:G393 COUNTY ROAD II
Mailing Address - Street 2:
Mailing Address - City:HAMLER
Mailing Address - State:OH
Mailing Address - Zip Code:43524-8701
Mailing Address - Country:US
Mailing Address - Phone:419-592-4357
Mailing Address - Fax:
Practice Address - Street 1:1445 NORTH SCOTT STREET
Practice Address - Street 2:#620
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-1049
Practice Address - Country:US
Practice Address - Phone:419-592-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE.00021539101YM0800X
OHI.5002001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH222661Medicaid