Provider Demographics
NPI:1336861285
Name:STONE, CASH JACKSON (LADC)
Entity Type:Individual
Prefix:
First Name:CASH
Middle Name:JACKSON
Last Name:STONE
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 RAYMOND AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1165
Mailing Address - Country:US
Mailing Address - Phone:719-200-5765
Mailing Address - Fax:
Practice Address - Street 1:1017 RAYMOND AVE APT 7
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1165
Practice Address - Country:US
Practice Address - Phone:719-200-5765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302227101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)