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General NPI Number Information
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NPI Number | 1316810351
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Entity Type | Individual
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Provider Name | JEANNETTE MARIE TETREAULT
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Gender | Female
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 202 N SCHUYLER AVE STE 205
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City | KANKAKEE
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State | IL
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Zip | 60901-3601
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Country | US
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Telephone | 815-348-4501
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Fax | 815-401-7672
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Provider Business Mailing Address
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Address Line | 445 BRIARCLIFF LN APT 1
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City | BOURBONNAIS
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State | IL
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Zip | 60914-1592
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Country | US
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Telephone | 815-348-4501
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Fax | 815-401-7672
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.000124
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License Number State | IL
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