Healthcare Provider Details

I. General information

NPI: 1962504308
Provider Name (Legal Business Name): SYLVIA SMOLENSKI CASSADY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 S KOKE MILL RD SUITE 204
SPRINGFIELD IL
62711-8058
US

IV. Provider business mailing address

2801 BLACKWATER BLVD
SPRINGFIELD IL
62712-8313
US

V. Phone/Fax

Practice location:
  • Phone: 217-553-4662
  • Fax:
Mailing address:
  • Phone: 217-553-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: