Provider Demographics
NPI:1942660394
Name:AUSSEM, KASANDRA (LISW-S)
Entity Type:Individual
Prefix:
First Name:KASANDRA
Middle Name:
Last Name:AUSSEM
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:KASANDRA
Other - Middle Name:
Other - Last Name:AUSSEM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW-S
Mailing Address - Street 1:9190 STONEGATE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-8952
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25111 COUNTRY CLUB BLVD STE 290
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-5330
Practice Address - Country:US
Practice Address - Phone:216-468-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.07004041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical