Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003267550 |
---|---|
Provider Name | Mrs. Cassandra Michelle Crum-Stratton |
First Address | Lexington, KY 40509 |
Second Address | Lexington, KY 40509-4266 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2016 |
Last Update Date | 27/06/2016 |