Provider Demographics
NPI:1578968244
Name:SPECK, CASSIE
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:SPECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 CROSSING CIRCLE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-8590
Mailing Address - Country:US
Mailing Address - Phone:855-729-2272
Mailing Address - Fax:615-250-6296
Practice Address - Street 1:4711 GOLF RD STE 920
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1247
Practice Address - Country:US
Practice Address - Phone:855-729-2272
Practice Address - Fax:224-330-1064
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN19304363LW0102X
IL209.026217363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health