Provider Demographics
NPI:1598786980
Name:KRASKA, KEVIN ANDREW (MSW, LISW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:ANDREW
Last Name:KRASKA
Suffix:
Gender:M
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2157
Mailing Address - Country:US
Mailing Address - Phone:614-470-2185
Mailing Address - Fax:614-470-2185
Practice Address - Street 1:24 E WEBER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1448
Practice Address - Country:US
Practice Address - Phone:614-470-2185
Practice Address - Fax:614-470-2185
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI7503-OH1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW16492Medicare UPIN