Provider Demographics
NPI:1134408180
Name:BESTOR, CASSANDRA (LCSW)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:
Last Name:BESTOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:RUSSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:907 W MARKETVIEW DR STE 10
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-1250
Mailing Address - Country:US
Mailing Address - Phone:217-262-9975
Mailing Address - Fax:
Practice Address - Street 1:1542 WILD GOOSE RUN
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-2503
Practice Address - Country:US
Practice Address - Phone:515-783-8719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA09028101YA0400X
IA007999104100000X
IL149.0189791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker