Provider Demographics
NPI:1619633757
Name:KINDER, KASSIDEY FAITH
Entity Type:Individual
Prefix:
First Name:KASSIDEY
Middle Name:FAITH
Last Name:KINDER
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 1:7347 BIRCH CIR
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-4510
Mailing Address - Country:US
Mailing Address - Phone:208-292-7167
Mailing Address - Fax:
Practice Address - Street 1:7347 BIRCH CIR
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-4510
Practice Address - Country:US
Practice Address - Phone:208-292-7167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician