Healthcare Provider Details

I. General information

NPI: 1265365126
Provider Name (Legal Business Name): MAIKO YANAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 WASHINGTON ST APT 1W
EVANSTON IL
60202-1624
US

IV. Provider business mailing address

1330 WASHINGTON ST APT 1W
EVANSTON IL
60202-1624
US

V. Phone/Fax

Practice location:
  • Phone: 847-630-3994
  • Fax:
Mailing address:
  • Phone: 847-630-3994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180009030
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: