Healthcare Provider Details

I. General information

NPI: 1962643999
Provider Name (Legal Business Name): JEANNE YAKIN LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2009
Last Update Date: 05/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LAKE COOK RD SUITE 350
DEERFIELD IL
60015-5609
US

IV. Provider business mailing address

500 LAKE COOK RD SUITE 350
DEERFIELD IL
60015-5609
US

V. Phone/Fax

Practice location:
  • Phone: 847-597-7047
  • Fax: 847-282-5001
Mailing address:
  • Phone: 847-597-7047
  • Fax: 847-282-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071.007436
License Number StateIL

VIII. Authorized Official

Name: JEANNE YAKIN
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 312-342-0266