Healthcare Provider Details

I. General information

NPI: 1821602723
Provider Name (Legal Business Name): YENISIS DE LOS SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 S ARLINGTON HEIGHTS RD STE 116
ARLINGTON HEIGHTS IL
60005-4142
US

IV. Provider business mailing address

1414 MAIN ST
MELROSE PARK IL
60160-3902
US

V. Phone/Fax

Practice location:
  • Phone: 847-666-5339
  • Fax:
Mailing address:
  • Phone: 708-681-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149031748
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: