Provider Demographics
NPI:1235670225
Name:ROBINSON, KASSIDY
Entity Type:Individual
Prefix:
First Name:KASSIDY
Middle Name:
Last Name:ROBINSON
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:PO BOX 342
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:UT
Mailing Address - Zip Code:84654-0342
Mailing Address - Country:US
Mailing Address - Phone:435-669-7650
Mailing Address - Fax:
Practice Address - Street 1:3 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:UT
Practice Address - Zip Code:84654-1358
Practice Address - Country:US
Practice Address - Phone:435-669-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9435742-3904101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health