MEDICARE: YANIZ A RAYO MA

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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1720573983	OTHER	IL	PRIVATE PRACTICE

General Provider Information

NPI Number	:	1841907532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANIZ A RAYO MA

Provider Business Mailing Address
First Line	:	13305 S RIDGELAND AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1808
Country	:	US
Telephone Number	:	708-907-5149
Fax Number	:	708-907-5294

Provider Business Practice Location Address
First Line	:	13305 S RIDGELAND AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1808
Country	:	US
Telephone Number	:	708-907-5149
Fax Number	:	708-907-5294

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

Provider Enumeration Date	:	11/01/2022
Last Update Date	:	11/01/2022

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Directions to “ YANIZ A RAYO MA” Practice Location

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