MEDICARE: MRS. CASSIE CAPRICE RENNELS L.P.C.

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		IL

General Provider Information

NPI Number	:	1982825022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CASSIE CAPRICE RENNELS L.P.C.

Provider Business Mailing Address
First Line	:	9310 APRIL LN
Second Line	:
City	:	ASHMORE
State	:	IL
Zip	:	61912-9123
Country	:	US
Telephone Number	:	217-348-8150
Fax Number	:	217-348-8150

Provider Business Practice Location Address
First Line	:	9310 APRIL LN
Second Line	:
City	:	ASHMORE
State	:	IL
Zip	:	61912-9123
Country	:	US
Telephone Number	:	217-348-8150
Fax Number	:	217-348-8150

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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