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General NPI Number Information
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NPI Number | 1700719796
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Entity Type | Individual
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Provider Name | CASSANDRA L. WEAVER
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Gender | Female
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 19150 KEDZIE AVE STE 201
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City | HOMEWOOD
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State | IL
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Zip | 60430-4541
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Country | US
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Telephone | 708-300-8864
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Fax |
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Provider Business Mailing Address
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Address Line | 330 SHORE DR
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City | HARVEY
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State | IL
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Zip | 60426-1276
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Country | US
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Telephone | 708-595-4646
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Fax | 708-595-4646
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 178015003
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License Number State | IL
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