MEDICARE: CASSIE SPECK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	19304	TN
2	363LW0102X	Women's Health Nurse Practitioner	209.026217	IL

General Provider Information

NPI Number	:	1578968244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSIE SPECK

Provider Business Mailing Address
First Line	:	5002 CROSSING CIRCLE
Second Line	:	SUITE 260
City	:	MT JULIET
State	:	TN
Zip	:	37122-8590
Country	:	US
Telephone Number	:	855-729-2272
Fax Number	:	615-250-6296

Provider Business Practice Location Address
First Line	:	4711 GOLF RD STE 920
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60076-1247
Country	:	US
Telephone Number	:	855-729-2272
Fax Number	:	224-330-1064

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2014
Last Update Date	:	02/13/2023

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Directions to “ CASSIE SPECK ” Practice Location

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