Provider Demographics
NPI:1730733767
Name:TRUMPY, CASSANDRA B (RBT)
Entity type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:B
Last Name:TRUMPY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:MRS
Other - First Name:CASSANDRA
Other - Middle Name:BLAIRE
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1312 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-5715
Mailing Address - Country:US
Mailing Address - Phone:309-349-6177
Mailing Address - Fax:
Practice Address - Street 1:1312 S 5TH ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-5715
Practice Address - Country:US
Practice Address - Phone:309-349-6177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician