Kassondra Lorol Gustafson, LPCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

201 28TH Ave SW
Willmar, MN 56201-5241

Phone

(320) 214-8558

Fax

(320) 235-2733

NPI assigned

Dec 4, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kassondra Lorol Linbo Former name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Crossroads Counseling Centers, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Willmar, MN
  • NPI 1437160264
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725494400000",
    "number": "1831794973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 SILVER LAKE RD NW STE 110",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551121789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 28TH AVE SW",
            "city": "WILLMAR",
            "state": "MN",
            "postal_code": "562015241",
            "telephone_number": "320-214-8558",
            "fax_number": "320-235-2733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUSTAFSON",
        "first_name": "KASSONDRA",
        "middle_name": "LOROL",
        "credential": "LPCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-04",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KASSONDRA",
            "last_name": "LINBO",
            "middle_name": "LOROL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michelle Lee Greydanus
• Jane Groen
• Breanna Mae Gronli, MSW, LICSW, SEP
• Gary J. Gronstedt, D.O.
• Abbey Guggisberg, LMFT
• Jonathan C Haas, MD
• Brenda Lynn Habedank, RPH
• Jon Haefner, D.C.
• Carly Hagemeyer, PHARM.D.
• Hagen Orthotics and Prosthetics

• Mental Health Counselor in Willmar, MN
• Providers in Willmar, MN by specialty
• Mental Health Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.