Healthcare Provider Details

I. General information

NPI: 1295040681
Provider Name (Legal Business Name): J. HOWARD AND ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 N MAIN ST SUITE 203
GLEN ELLYN IL
60137-5118
US

IV. Provider business mailing address

444 N MAIN ST SUITE 203
GLEN ELLYN IL
60137-5118
US

V. Phone/Fax

Practice location:
  • Phone: 630-474-9029
  • Fax: 630-474-9028
Mailing address:
  • Phone: 630-474-9029
  • Fax: 630-474-9028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number036123850
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number180006925
License Number StateIL

VIII. Authorized Official

Name: DR. JONATHAN HOWARD
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 630-474-9029