Provider Demographics
NPI:1821853359
Name:SUITER, KASSIDY LYN (BA)
Entity Type:Individual
Prefix:
First Name:KASSIDY
Middle Name:LYN
Last Name:SUITER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3430 E KIMBERLY RD APT 138
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2525
Mailing Address - Country:US
Mailing Address - Phone:563-343-7635
Mailing Address - Fax:
Practice Address - Street 1:1523 S FAIRMOUNT ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802-3644
Practice Address - Country:US
Practice Address - Phone:563-322-2667
Practice Address - Fax:563-322-3671
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)