Provider Demographics
NPI:1518699768
Name:BUCKELEW, CASSIDY (PSYD)
Entity type:Individual
Prefix:DR
First Name:CASSIDY
Middle Name:
Last Name:BUCKELEW
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 1:708 CHURCH ST STE 233
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3885
Mailing Address - Country:US
Mailing Address - Phone:708-292-8373
Mailing Address - Fax:708-816-2190
Practice Address - Street 1:708 CHURCH ST STE 233
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3885
Practice Address - Country:US
Practice Address - Phone:708-292-8373
Practice Address - Fax:708-816-2190
Is Sole Proprietor?:No
Enumeration Date:2022-06-27
Last Update Date:2025-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.011287103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty