Healthcare Provider Details

I. General information

NPI: 1063335644
Provider Name (Legal Business Name): KASIDEE NICOLE BAKER MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASIDEE NICOLE PASCOE MS CCC-SLP

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 W BASTANCHURY RD
FULLERTON CA
92833-2247
US

IV. Provider business mailing address

2801 MAIN ST APT 454
IRVINE CA
92614-5022
US

V. Phone/Fax

Practice location:
  • Phone: 714-870-2870
  • Fax:
Mailing address:
  • Phone: 530-402-5591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number40453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: