Basic Information
Provider Information | |||||||||
NPI: | 1851617781 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KRSKA | ||||||||
FirstName: | CYNTHIA | ||||||||
MiddleName: | LOU | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LICSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KRSKA | ||||||||
OtherFirstName: | CINDY | ||||||||
OtherMiddleName: | LOU | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LICSW | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 3450 OLEARY LN | ||||||||
Address2: |   | ||||||||
City: | EAGAN | ||||||||
State: | MN | ||||||||
PostalCode: | 551232340 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6513658242 | ||||||||
FaxNumber: | 6514543492 | ||||||||
Practice Location | |||||||||
Address1: | 3450 OLEARY LN | ||||||||
Address2: |   | ||||||||
City: | EAGAN | ||||||||
State: | MN | ||||||||
PostalCode: | 551232340 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6513658242 | ||||||||
FaxNumber: | 6514543492 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/16/2010 | ||||||||
LastUpdateDate: | 04/19/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 16524 | MN | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.