MEDICARE: MRS. KASSIE MARIE DAVALOS MSE, MA, CCC--SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist
2	235Z00000X	Speech-Language Pathologist	187	SD

General Provider Information

NPI Number	:	1083944458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KASSIE MARIE DAVALOS MSE, MA, CCC--SLP

Provider Business Mailing Address
First Line	:	23777 PINE HAVEN DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-7407
Country	:	US
Telephone Number	:	605-661-4623
Fax Number	:

Provider Business Practice Location Address
First Line	:	23777 PINE HAVEN DR
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57702-7407
Country	:	US
Telephone Number	:	605-661-4623
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2010
Last Update Date	:	04/12/2025

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Directions to “ MRS. KASSIE MARIE DAVALOS MSE, MA, CCC--SLP” Practice Location

Language	Start Address	Practice Location

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