Provider Demographics
NPI:1598346264
Name:SLOANE, CASSANDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:SLOANE
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 1:190 MYSTIC MOON RD
Mailing Address - Street 2:
Mailing Address - City:BONNER
Mailing Address - State:MT
Mailing Address - Zip Code:59823-9780
Mailing Address - Country:US
Mailing Address - Phone:406-922-7936
Mailing Address - Fax:
Practice Address - Street 1:44 N VIRGINIA ST STE 3B
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-4154
Practice Address - Country:US
Practice Address - Phone:815-363-0864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350909032001Medicaid