Provider Demographics
NPI:1255853263
Name:MOORE, KASSIDY PAIGE (AUD)
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:PAIGE
Last Name:MOORE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 PLUM CREEK DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-1601
Mailing Address - Country:US
Mailing Address - Phone:806-355-9999
Mailing Address - Fax:806-355-9989
Practice Address - Street 1:6830 PLUM CREEK DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79124-1601
Practice Address - Country:US
Practice Address - Phone:806-355-9999
Practice Address - Fax:806-355-9989
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80886231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist