Provider Demographics
NPI:1578271946
Name:MACKIN, CASSANDRA (MSW)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:MACKIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:MOSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:448 WYLIE DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-5405
Mailing Address - Country:US
Mailing Address - Phone:618-512-1803
Mailing Address - Fax:
Practice Address - Street 1:50 NORTHGATE INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-6805
Practice Address - Country:US
Practice Address - Phone:161-887-7442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IL150.112289104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor