Basic Information
| Provider Information | |||||||||
| NPI: | 1548269384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOWELL-CANADA | ||||||||
| FirstName: | CECILIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 N EAST ST | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624502432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183955222 | ||||||||
| FaxNumber: | 6183958552 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 N EAST ST | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624502432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183955222 | ||||||||
| FaxNumber: | 6183958552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 12/30/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 34133 | WI | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 5749 | AK | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 036-136835 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | MD5506 | 05 | AK | MEDICAID | 31933700 | 05 | WI | MEDICAID |