Provider Demographics
NPI:1265949689
Name:CRAMBLETT, KASSIDY (MSCCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KASSIDY
Middle Name:
Last Name:CRAMBLETT
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-2323
Mailing Address - Country:US
Mailing Address - Phone:501-454-6823
Mailing Address - Fax:
Practice Address - Street 1:319 N PINE ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-4215
Practice Address - Country:US
Practice Address - Phone:501-447-5919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR221770721Medicaid