Active NPI
Kendal Cassidy, PH.D
- Psychologist
- Tacoma, WA
National Provider Identifier
1306431291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY61098659
- Practice address
- 4115 N 21St St
Tacoma, WA 98406-4818 - Phone
- (253) 317-3449
- NPI assigned
- Mar 3, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY61098659 | WA | Primary |
Addresses
Primary practice location
4115 N 21St St
Tacoma, WA 98406-4818
Mailing address
4115 N 21St St
Tacoma, WA 98406-4818
Phone (253) 317-3449
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective May 21, 2021 through May 21, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY61098659 | WA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1614729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614729600000",
"number": "1306431291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4115 N 21ST ST",
"city": "TACOMA",
"state": "WA",
"postal_code": "984064818",
"telephone_number": "253-317-3449"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4115 N 21ST ST",
"city": "TACOMA",
"state": "WA",
"postal_code": "984064818",
"telephone_number": "253-317-3449"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CASSIDY",
"first_name": "KENDAL",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-03-03",
"last_updated": "2021-03-03",
"certification_date": "2021-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WA",
"license": "PY61098659",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.