Provider Demographics
NPI:1891119392
Name:HOWARD, JEANNIE MARIE
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:MARIE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:MARIE
Other - Last Name:SLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC
Mailing Address - Street 1:2233 N WINTERGREEN LOOP
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-4265
Mailing Address - Country:US
Mailing Address - Phone:270-570-1384
Mailing Address - Fax:
Practice Address - Street 1:2233 N WINTERGREEN LOOP
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4265
Practice Address - Country:US
Practice Address - Phone:270-570-1384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0440101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional