Healthcare Provider Details

I. General information

NPI: 1679226930
Provider Name (Legal Business Name): CASSANDRA L EILERS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSANDRA L SMART

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E BIDWELL ST
TAYLORVILLE IL
62568-1363
US

IV. Provider business mailing address

201 E MADISON ST STE 328
SPRINGFIELD IL
62702-5131
US

V. Phone/Fax

Practice location:
  • Phone: 217-824-3566
  • Fax: 217-824-1344
Mailing address:
  • Phone: 217-545-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.025977
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: