Healthcare Provider Details

I. General information

NPI: 1033323464
Provider Name (Legal Business Name): JOEL JB CAGWIN MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W PIERCE ST
ELBURN IL
60119-8201
US

IV. Provider business mailing address

3S261 BRIARWOOD DR
WARRENVILLE IL
60555-2629
US

V. Phone/Fax

Practice location:
  • Phone: 630-365-0899
  • Fax: 630-365-9150
Mailing address:
  • Phone: 630-365-0899
  • Fax: 630-365-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: