Provider Demographics
NPI:1356171920
Name:STANFORD, KASSIDY RENEE (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:RENEE
Last Name:STANFORD
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 TRANQUILITY LAKE BLVD APT 2107
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4663
Mailing Address - Country:US
Mailing Address - Phone:337-351-2329
Mailing Address - Fax:
Practice Address - Street 1:5350 MAGNOLIA PKWY
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9043
Practice Address - Country:US
Practice Address - Phone:281-727-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122601235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist