Provider Demographics
NPI:1770986770
Name:KASSER, VIRGINIA G (PHD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:G
Last Name:KASSER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:GROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:575 N KELLOGG
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401
Mailing Address - Country:US
Mailing Address - Phone:309-343-0800
Mailing Address - Fax:
Practice Address - Street 1:575 N KELLOGG
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401
Practice Address - Country:US
Practice Address - Phone:309-343-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005306103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical