Healthcare Provider Details

I. General information

NPI: 1679356091
Provider Name (Legal Business Name): YEKSENY GUERRERO MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 GRAND AVE
FRANKLIN PARK IL
60131-2563
US

IV. Provider business mailing address

1962 N 18TH AVE APT 12
MELROSE PARK IL
60160-1224
US

V. Phone/Fax

Practice location:
  • Phone: 847-451-5067
  • Fax:
Mailing address:
  • Phone: 224-399-6885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: