Provider Demographics
NPI:1346372869
Name:DASCH, CYNTHIA SUE (MS LICSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:SUE
Last Name:DASCH
Suffix:
Gender:F
Credentials:MS LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 VAN BUREN ST
Mailing Address - Street 2:SUITE 4C
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-1782
Mailing Address - Country:US
Mailing Address - Phone:763-421-2047
Mailing Address - Fax:763-421-2810
Practice Address - Street 1:241 VAN BUREN ST
Practice Address - Street 2:SUITE 4C
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-1782
Practice Address - Country:US
Practice Address - Phone:763-421-2047
Practice Address - Fax:763-421-2810
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN129861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical