Provider Demographics
NPI:1184795098
Name:DAVIS, CASSANDRA MARIE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:IL
Mailing Address - Zip Code:62075-1489
Mailing Address - Country:US
Mailing Address - Phone:618-910-4975
Mailing Address - Fax:
Practice Address - Street 1:201 E PLEASANT ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1562
Practice Address - Country:US
Practice Address - Phone:618-910-4975
Practice Address - Fax:217-824-1854
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.007354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist