Healthcare Provider Details

I. General information

NPI: 1497284277
Provider Name (Legal Business Name): CASSANDRA GRACE MACMILLAN LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 LAMAR AVE STE 130
MISSION KS
66202-3234
US

IV. Provider business mailing address

1640 ILLINOIS ST
LAWRENCE KS
66044-4040
US

V. Phone/Fax

Practice location:
  • Phone: 913-826-4200
  • Fax:
Mailing address:
  • Phone: 785-221-6275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05535
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10386
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: