=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629589569
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANINE CANGIALOSI LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2017
-----------------------------------------------------
Last Update Date | 10/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1608 W COLONIAL PKWY STE 101
-----------------------------------------------------
City | INVERNESS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60067-4755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-522-1430
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 224 OAKWOOD DR
-----------------------------------------------------
City | WOOD DALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60191-1954
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-552-1430
-----------------------------------------------------
Fax | 847-305-3020
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180.010777
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------