MEDICARE: JILL KOENIG PCC-S

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	E0003369	OH

General Provider Information

NPI Number	:	1891145629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL KOENIG PCC-S

Provider Business Mailing Address
First Line	:	3100 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2508
Country	:	US
Telephone Number	:	216-361-9100
Fax Number	:	216-361-7774

Provider Business Practice Location Address
First Line	:	3100 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2508
Country	:	US
Telephone Number	:	216-361-9100
Fax Number	:	216-361-7774

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

Provider Enumeration Date	:	06/13/2016
Last Update Date	:	06/13/2016

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