Healthcare Provider Details

I. General information

NPI: 1447333505
Provider Name (Legal Business Name): JEANNINE MARIE PACETTI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 EMILY CT
YORKVILLE IL
60560-9129
US

IV. Provider business mailing address

338 EMILY CT
YORKVILLE IL
60560-9129
US

V. Phone/Fax

Practice location:
  • Phone: 630-639-0096
  • Fax:
Mailing address:
  • Phone: 630-639-0096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.013284
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number852925
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: