Provider Demographics
NPI:1851617781
Name:KRSKA, CYNTHIA LOU (LICSW)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOU
Last Name:KRSKA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:LOU
Other - Last Name:KRSKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:3450 OLEARY LN
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-2340
Mailing Address - Country:US
Mailing Address - Phone:651-365-8242
Mailing Address - Fax:651-454-3492
Practice Address - Street 1:3450 OLEARY LN
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55123-2340
Practice Address - Country:US
Practice Address - Phone:651-365-8242
Practice Address - Fax:651-454-3492
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN165241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical