MEDICARE: MS. CASSANDRA HOWARD LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor		IL

General Provider Information

NPI Number	:	1609045723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CASSANDRA HOWARD LCPC

Provider Business Mailing Address
First Line	:	16642 KENWOOD AVE
Second Line	:
City	:	SOUTH HOLLAND
State	:	IL
Zip	:	60473-3221
Country	:	US
Telephone Number	:	773-484-0854
Fax Number	:	708-893-0261

Provider Business Practice Location Address
First Line	:	1130 S WABASH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2372
Country	:	US
Telephone Number	:	773-484-0854
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	02/22/2008

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