Healthcare Provider Details

I. General information

NPI: 1780178210
Provider Name (Legal Business Name): CASSONDRA MARIE NATION
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 EAGLE RIDGE DR
CHATHAM IL
62629-2008
US

IV. Provider business mailing address

409 EAGLE RIDGE DR
CHATHAM IL
62629-2008
US

V. Phone/Fax

Practice location:
  • Phone: 217-280-3726
  • Fax: 217-670-2582
Mailing address:
  • Phone: 217-280-3726
  • Fax: 217-670-2582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: