Healthcare Provider Details

I. General information

NPI: 1649480708
Provider Name (Legal Business Name): YOLANDA V LOERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 E WASHINGTON ST
CHAMPAIGN IL
61820-3652
US

IV. Provider business mailing address

2110 W WHITE ST APT#152
CHAMPAIGN IL
61821-2936
US

V. Phone/Fax

Practice location:
  • Phone: 217-398-7785
  • Fax: 217-398-7787
Mailing address:
  • Phone: 217-840-8302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: