Provider Demographics
NPI:1013794460
Name:LEVIS, KASSIDY
Entity Type:Individual
Prefix:
First Name:KASSIDY
Middle Name:
Last Name:LEVIS
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 1:8300 CENTRAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6667
Mailing Address - Country:US
Mailing Address - Phone:254-537-4414
Mailing Address - Fax:
Practice Address - Street 1:8300 CENTRAL PARK DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6667
Practice Address - Country:US
Practice Address - Phone:254-537-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81032237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist