MEDICARE: MRS. JEANINE JENNIFER CANNELLA HOWE LCPC, CDVP

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	101YP2500X	Professional Counselor	180005370	IL

General Provider Information

NPI Number	:	1679803936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANINE JENNIFER CANNELLA HOWE LCPC, CDVP

Provider Business Mailing Address
First Line	:	3047 N LINCOLN AVE UNIT 400
Second Line	:	3S
City	:	CHICAGO
State	:	IL
Zip	:	60657-4274
Country	:	US
Telephone Number	:	630-935-1501
Fax Number	:	773-404-5837

Provider Business Practice Location Address
First Line	:	3047 N LINCOLN AVE
Second Line	:	400
City	:	CHICAGO
State	:	IL
Zip	:	60657-4999
Country	:	US
Telephone Number	:	630-935-1501
Fax Number	:

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

Provider Enumeration Date	:	01/10/2010
Last Update Date	:	10/03/2011

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