NPIMap

Individual provider Active NPI

Kassidy Haslacker, PSYCHOLOGIST

  • School Psychologist
  • Petersburg, WV
National Provider Identifier
1942667993
Registry record updated Jan 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
School PsychologistTaxonomy code 103TS0200X
License
22064 Issued in WV
Practice address
204 Jefferson Avenue
Grant County Board of Education
Petersburg, WV 26847
Phone
(304) 267-3595
Fax
(304) 267-3599
NPI assigned
Jan 21, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 21, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School Psychologist 103TS0200X 22064 WV Primary

Addresses

Primary practice location

204 Jefferson Avenue
Grant County Board of Education
Petersburg, WV 26847

Mailing address

204 Jefferson Avenue
Grant County Board of Education
Petersburg, WV 26847
Phone (304) 267-3595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Grant County Board of Education Past Accepting new patients
Grant County Board of Education Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1453334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453334400000",
    "number": "1942667993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 JEFFERSON AVENUE",
            "address_2": "GRANT COUNTY BOARD OF EDUCATION",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "26847",
            "telephone_number": "304-267-3595",
            "fax_number": "304-267-3599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 JEFFERSON AVENUE",
            "address_2": "GRANT COUNTY BOARD OF EDUCATION",
            "city": "PETERSBURG",
            "state": "WV",
            "postal_code": "26847",
            "telephone_number": "304-267-3595",
            "fax_number": "304-267-3599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASLACKER",
        "first_name": "KASSIDY",
        "credential": "PSYCHOLOGIST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-01-21",
        "last_updated": "2016-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "WV",
            "license": "22064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petersburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.