Provider Demographics
NPI:1962124461
Name:ASHBECK, KASSIDY DYANNE
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:DYANNE
Last Name:ASHBECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 E KANE PL APT 107
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1748
Mailing Address - Country:US
Mailing Address - Phone:715-889-4537
Mailing Address - Fax:
Practice Address - Street 1:525 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53203-2703
Practice Address - Country:US
Practice Address - Phone:414-288-6187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty