Healthcare Provider Details

I. General information

NPI: 1104209832
Provider Name (Legal Business Name): TANIA M YACKLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 07/18/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 OGDEN AVE STE 144
DOWNERS GROVE IL
60515-2829
US

IV. Provider business mailing address

4520 DRENDEL RD
DOWNERS GROVE IL
60515-2421
US

V. Phone/Fax

Practice location:
  • Phone: 630-474-1257
  • Fax:
Mailing address:
  • Phone: 312-301-3820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.009344
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: