Provider Demographics
NPI:1184324170
Name:GUERRERO, KASSIDI B
Entity type:Individual
Prefix:
First Name:KASSIDI
Middle Name:B
Last Name:GUERRERO
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 1:4276 SPRUCE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-1132
Mailing Address - Country:US
Mailing Address - Phone:815-910-5274
Mailing Address - Fax:
Practice Address - Street 1:4276 SPRUCE ST APT 2
Practice Address - Street 2:
Practice Address - City:FORT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-1132
Practice Address - Country:US
Practice Address - Phone:815-910-5274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2000091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical