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NPI Code Detail

MEDICARE: CONSTANCE RENAE WHITE MA

MEDICARE: CONSTANCE RENAE WHITE MA
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
1101Y00000XCounselorIL

General Provider Information

NPI Number : 1649619537
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONSTANCE RENAE WHITE MA
Provider Business Mailing Address
First Line : 2707 3 OAKS RD UNIT 932
Second Line :
City : CARY
State : IL
Zip : 60013-3525
Country : US
Telephone Number : 224-432-6419
Fax Number :
Provider Business Practice Location Address
First Line : 500 COVENTRY LN STE 130
Second Line :
City : CRYSTAL LAKE
State : IL
Zip : 60014-7578
Country : US
Telephone Number : 815-889-0582
Fax Number : 815-205-4083
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2013
Last Update Date : 12/04/2024

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Directions to “ CONSTANCE RENAE WHITE MA” Practice Location

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