MEDICARE: DR. YVETTE MICHELLE BOLES PSY.D.

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1578152617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YVETTE MICHELLE BOLES PSY.D.

Provider Business Mailing Address
First Line	:	4250 N MARINE DR STE 230
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-6209
Country	:	US
Telephone Number	:	872-529-1991
Fax Number	:

Provider Business Practice Location Address
First Line	:	4250 N MARINE DR STE 230
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-6209
Country	:	US
Telephone Number	:	872-529-1991
Fax Number	:

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

Provider Enumeration Date	:	01/13/2021
Last Update Date	:	01/13/2021

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