Provider Demographics
NPI:1043016041
Name:HANSEN, KASSIDY A
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:A
Last Name:HANSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25849 LORENZO RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60481-9329
Mailing Address - Country:US
Mailing Address - Phone:815-823-7395
Mailing Address - Fax:
Practice Address - Street 1:449 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-8857
Practice Address - Country:US
Practice Address - Phone:815-600-3076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty