Provider Demographics
NPI:1225895527
Name:BRITTAIN, KASSIDY FAITH
Entity Type:Individual
Prefix:
First Name:KASSIDY
Middle Name:FAITH
Last Name:BRITTAIN
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 1:706 E ROLLING VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67147-7314
Mailing Address - Country:US
Mailing Address - Phone:316-288-0951
Mailing Address - Fax:
Practice Address - Street 1:3510 W CENTRAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4951
Practice Address - Country:US
Practice Address - Phone:316-251-0764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14484923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist