Provider Demographics
NPI:1174204523
Name:REILLY, CASSANDRA LYN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:LYN
Last Name:REILLY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 N 27TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3604
Mailing Address - Country:US
Mailing Address - Phone:920-946-9628
Mailing Address - Fax:
Practice Address - Street 1:1245 CHEYENNE AVE STE 200
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9323
Practice Address - Country:US
Practice Address - Phone:262-233-1818
Practice Address - Fax:262-421-8681
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker