Provider Demographics
NPI:1063258150
Name:HICKMAN, KASSY LAYNE (AUDIOLOGIST)
Entity type:Individual
Prefix:
First Name:KASSY
Middle Name:LAYNE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:AUDIOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 FALL HILL AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3511
Mailing Address - Country:US
Mailing Address - Phone:540-371-1263
Mailing Address - Fax:
Practice Address - Street 1:1708 FALL HILL AVE STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3511
Practice Address - Country:US
Practice Address - Phone:540-371-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2205000007231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist