Provider Demographics
NPI:1487842548
Name:GLOVER, CASSANDRA DEANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:DEANN
Last Name:GLOVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5583 WHEAT DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61102-3891
Mailing Address - Country:US
Mailing Address - Phone:815-969-8245
Mailing Address - Fax:815-966-3011
Practice Address - Street 1:5583 WHEAT DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61102-3891
Practice Address - Country:US
Practice Address - Phone:815-969-8245
Practice Address - Fax:815-966-3011
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2271925101YS0200X
IL19448121041S0200X
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool