Provider Demographics
NPI:1851630578
Name:WANK, CASSADY MAY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CASSADY
Middle Name:MAY
Last Name:WANK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1958 ABERDEEN CT
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3175
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1958 ABERDEEN CT
Practice Address - Street 2:SUITE 2
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3175
Practice Address - Country:US
Practice Address - Phone:815-999-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008508103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical