Provider Demographics
NPI:1174990659
Name:KROTOVA, ALEKSANDRA E (LCSW)
Entity type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:E
Last Name:KROTOVA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:
Other - Last Name:KROTOVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1224 WASHINGTON AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-5055
Mailing Address - Country:US
Mailing Address - Phone:509-230-6030
Mailing Address - Fax:406-282-1634
Practice Address - Street 1:1224 WASHINGTON AVE STE 206
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-5055
Practice Address - Country:US
Practice Address - Phone:406-282-1634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1427003862Medicaid
OR500673381Medicaid