Healthcare Provider Details

I. General information

NPI: 1497470280
Provider Name (Legal Business Name): MERCEDES YATES-JONES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 WARRENVILLE RD STE 450-29
LISLE IL
60532-1000
US

IV. Provider business mailing address

3030 WARRENVILLE RD STE 450-29
LISLE IL
60532-1000
US

V. Phone/Fax

Practice location:
  • Phone: 312-774-4677
  • Fax: 312-564-5151
Mailing address:
  • Phone: 312-774-4677
  • Fax: 312-564-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149029075
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904019032
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: