Healthcare Provider Details

I. General information

NPI: 1023989043
Provider Name (Legal Business Name): NYIA DYKES ALMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 N RAVENSWOOD AVE
CHICAGO IL
60613-3880
US

IV. Provider business mailing address

3717 N RAVENSWOOD AVE
CHICAGO IL
60613-3880
US

V. Phone/Fax

Practice location:
  • Phone: 312-612-0044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number208.011444
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: