Healthcare Provider Details

I. General information

NPI: 1992132849
Provider Name (Legal Business Name): YAKOS THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2013
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E COURT ST STE 708
KANKAKEE IL
60901-3845
US

IV. Provider business mailing address

200 E COURT ST STE 708
KANKAKEE IL
60901-3845
US

V. Phone/Fax

Practice location:
  • Phone: 815-304-5548
  • Fax: 815-304-5548
Mailing address:
  • Phone: 815-304-5548
  • Fax: 815-304-5548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number146011221
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA YAKOS
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MHS, CCC-SLP/L
Phone: 815-304-5548