Provider Demographics
NPI:1376986422
Name:FLACK, CASSIE DEANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:DEANN
Last Name:FLACK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CASSIE
Other - Middle Name:DEANN
Other - Last Name:SHUEMAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3308 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-3615
Mailing Address - Country:US
Mailing Address - Phone:217-821-9715
Mailing Address - Fax:
Practice Address - Street 1:3308 CHESTNUT AVE
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-3615
Practice Address - Country:US
Practice Address - Phone:217-821-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.009824235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist