Provider Demographics
NPI:1235511270
Name:VONKROSIGK, CASSANDRA
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:VONKROSIGK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MISSOURI VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SHOSHONI
Mailing Address - State:WY
Mailing Address - Zip Code:82649-8603
Mailing Address - Country:US
Mailing Address - Phone:307-856-6331
Mailing Address - Fax:
Practice Address - Street 1:75 MISSOURI VALLEY RD
Practice Address - Street 2:
Practice Address - City:SHOSHONI
Practice Address - State:WY
Practice Address - Zip Code:82649-8603
Practice Address - Country:US
Practice Address - Phone:307-856-6331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child