Provider Demographics
NPI:1982342689
Name:MCDONALD, KASSIDY LEE
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:LEE
Last Name:MCDONALD
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 1:3116 S OPECHEE DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47302-5528
Mailing Address - Country:US
Mailing Address - Phone:765-716-4861
Mailing Address - Fax:
Practice Address - Street 1:1707 BETHANY RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-9669
Practice Address - Country:US
Practice Address - Phone:765-393-9083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist