MEDICARE: CASSONDRA MARIE NATION

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1780178210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSONDRA MARIE NATION

Provider Business Mailing Address
First Line	:	409 EAGLE RIDGE DR
Second Line	:
City	:	CHATHAM
State	:	IL
Zip	:	62629-2008
Country	:	US
Telephone Number	:	217-280-3726
Fax Number	:	217-670-2582

Provider Business Practice Location Address
First Line	:	409 EAGLE RIDGE DR
Second Line	:
City	:	CHATHAM
State	:	IL
Zip	:	62629-2008
Country	:	US
Telephone Number	:	217-280-3726
Fax Number	:	217-670-2582

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

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	12/03/2025

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Directions to “ CASSONDRA MARIE NATION ” Practice Location

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