Healthcare Provider Details

I. General information

NPI: 1932529682
Provider Name (Legal Business Name): YOLANDA PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6826 S TALMAN AVE # 2
CHICAGO IL
60629-1824
US

IV. Provider business mailing address

6826 S TALMAN AVE # 2
CHICAGO IL
60629-1824
US

V. Phone/Fax

Practice location:
  • Phone: 773-505-8489
  • Fax:
Mailing address:
  • Phone: 773-505-8489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number2559359
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: