Provider Demographics
NPI:1487399275
Name:AMBERGER, CASSANDRA (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:AMBERGER
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:NORRIS CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62869-0399
Mailing Address - Country:US
Mailing Address - Phone:618-378-3212
Mailing Address - Fax:618-378-3902
Practice Address - Street 1:580 U.S. HWY 45 S.
Practice Address - Street 2:
Practice Address - City:NORRIS CITY
Practice Address - State:IL
Practice Address - Zip Code:62869-0399
Practice Address - Country:US
Practice Address - Phone:618-378-3212
Practice Address - Fax:618-378-3902
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242006646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242006646Medicaid