Healthcare Provider Details

I. General information

NPI: 1114662954
Provider Name (Legal Business Name): YESENIA VELAZQUEZ M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 DUNDEE RD STE 418
NORTHBROOK IL
60062-2436
US

IV. Provider business mailing address

3000 DUNDEE RD STE 418
NORTHBROOK IL
60062-2436
US

V. Phone/Fax

Practice location:
  • Phone: 847-306-6477
  • Fax:
Mailing address:
  • Phone: 847-306-6477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.033442
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: