1679803936 NPI number — MRS. JEANINE JENNIFER CANNELLA HOWE LCPC, CDVP

Table of content: MRS. JEANINE JENNIFER CANNELLA HOWE LCPC, CDVP (NPI 1679803936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679803936 NPI number — MRS. JEANINE JENNIFER CANNELLA HOWE LCPC, CDVP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOWE
Provider First Name:
JEANINE
Provider Middle Name:
JENNIFER CANNELLA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCPC, CDVP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679803936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3047 N LINCOLN AVE UNIT 400
Provider Second Line Business Mailing Address:
3S
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60657-4274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-935-1501
Provider Business Mailing Address Fax Number:
773-404-5837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3047 N LINCOLN AVE
Provider Second Line Business Practice Location Address:
400
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657-4999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-935-1501
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180005370 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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