Provider Demographics
NPI:1083944458
Name:DAVALOS, KASSIE MARIE (MSE, MA, CCC--SLP)
Entity type:Individual
Prefix:MRS
First Name:KASSIE
Middle Name:MARIE
Last Name:DAVALOS
Suffix:
Gender:
Credentials:MSE, MA, CCC--SLP
Other - Prefix:
Other - First Name:KASSIE
Other - Middle Name:MARIE
Other - Last Name:EHRESMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:23777 PINE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-7407
Mailing Address - Country:US
Mailing Address - Phone:605-661-4623
Mailing Address - Fax:
Practice Address - Street 1:23777 PINE HAVEN DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-7407
Practice Address - Country:US
Practice Address - Phone:605-661-4623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
SD187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist