MEDICARE: JOEL JB CAGWIN MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1033323464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL JB CAGWIN MA

Provider Business Mailing Address
First Line	:	3S261 BRIARWOOD DR
Second Line	:
City	:	WARRENVILLE
State	:	IL
Zip	:	60555-2629
Country	:	US
Telephone Number	:	630-365-0899
Fax Number	:	630-365-9150

Provider Business Practice Location Address
First Line	:	106 W PIERCE ST
Second Line	:
City	:	ELBURN
State	:	IL
Zip	:	60119-8201
Country	:	US
Telephone Number	:	630-365-0899
Fax Number	:	630-365-9150

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/08/2007

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