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Individual
KASSIDY NEIDECKER
Active
Individual
KASSIDY NEIDECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QBHP
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
128707526
—
AR
Enumeration date
05/23/2017
Last updated
07/11/2019
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