Healthcare Provider Details

I. General information

NPI: 1598572380
Provider Name (Legal Business Name): YESENIA ZENDEJAS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2248 S MICHIGAN AVE
CHICAGO IL
60616-5258
US

IV. Provider business mailing address

3520 W 64TH PL
CHICAGO IL
60629-3717
US

V. Phone/Fax

Practice location:
  • Phone: 312-842-5083
  • Fax:
Mailing address:
  • Phone: 773-543-9412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: