Provider Demographics
NPI:1346781135
Name:RUNION, KASI AMANDA (HIS - BC)
Entity type:Individual
Prefix:MISS
First Name:KASI
Middle Name:AMANDA
Last Name:RUNION
Suffix:
Gender:F
Credentials:HIS - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3644 PEAVINE RD
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38571-7923
Mailing Address - Country:US
Mailing Address - Phone:931-709-0661
Mailing Address - Fax:931-709-0661
Practice Address - Street 1:1102 W WAUGH ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8769
Practice Address - Country:US
Practice Address - Phone:706-271-0999
Practice Address - Fax:706-271-0992
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHADS000945237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist