Active NPI
Cassidy Green
- Speech-Language Pathologist
- Aurora, IL
National Provider Identifier
1134723570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 242005789
- Practice address
- 1305 Long Grove Dr
Aurora, IL 60504-8990 - Phone
- (630) 375-3100
- NPI assigned
- Nov 25, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 242005789 | IL | Primary |
Addresses
Primary practice location
1305 Long Grove Dr
Aurora, IL 60504-8990
Mailing address
1 Paxson CT
Bolingbrook, IL 60440-9006
Phone (630) 618-8235
Other practice location 1
15507 Illinois Rte 59
Suite 4E
Plainfield, IL 60544
Phone (779) 234-8997
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 242005789 | IL | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1606262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606262400000",
"number": "1134723570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 PAXSON CT",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604409006",
"telephone_number": "630-618-8235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1305 LONG GROVE DR",
"city": "AURORA",
"state": "IL",
"postal_code": "605048990",
"telephone_number": "630-375-3100"
}
],
"practiceLocations": [
{
"address_1": "15507 Illinois Rte 59",
"address_2": "Suite 4E",
"address_purpose": "LOCATION",
"city": "Plainfield",
"state": "IL",
"postal_code": "60544",
"country_code": "US",
"telephone_number": "779-234-8997",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GREEN",
"first_name": "CASSIDY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-11-25",
"last_updated": "2020-11-25",
"certification_date": "2020-11-24",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "242005789",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Aurora, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.