1124085196 NPI number — MS. CAROL ROSE SASSE MSW, LCSW-PIP

Table of content: MS. CAROL ROSE SASSE MSW, LCSW-PIP (NPI 1124085196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124085196 NPI number — MS. CAROL ROSE SASSE MSW, LCSW-PIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SASSE
Provider First Name:
CAROL
Provider Middle Name:
ROSE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW-PIP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124085196
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 DOOLITTLE DR
Provider Second Line Business Mailing Address:
SUITE 1M08
Provider Business Mailing Address City Name:
ELLSWORTH AFB
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57706-4821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-385-3660
Provider Business Mailing Address Fax Number:
605-385-2030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 DOOLITTLE DR
Provider Second Line Business Practice Location Address:
SUITE 1M08
Provider Business Practice Location Address City Name:
ELLSWORTH AFB
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57706-4821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-385-3660
Provider Business Practice Location Address Fax Number:
605-385-2030
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  2069 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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