Healthcare Provider Details

I. General information

NPI: 1245156454
Provider Name (Legal Business Name): CASANDRA TWADDLE M.S. SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 FRANKLIN AVE # L500
NORMAL IL
61761-3551
US

IV. Provider business mailing address

903 N LINDEN ST # B15
NORMAL IL
61761-1721
US

V. Phone/Fax

Practice location:
  • Phone: 309-452-0069
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.018770
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: