Healthcare Provider Details

I. General information

NPI: 1710321534
Provider Name (Legal Business Name): MS. JITTAUN YVETTE BOBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2013
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S STATE ST
CHICAGO IL
60604-3900
US

IV. Provider business mailing address

8641 S YATES BLVD
CHICAGO IL
60617-2319
US

V. Phone/Fax

Practice location:
  • Phone: 312-747-0036
  • Fax:
Mailing address:
  • Phone: 773-930-9694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: