Healthcare Provider Details

I. General information

NPI: 1699310524
Provider Name (Legal Business Name): YVETTE T OLSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E IRVING PARK RD
STREAMWOOD IL
60107-3201
US

IV. Provider business mailing address

590 AUDUBON ST
HOFFMAN ESTATES IL
60169-1974
US

V. Phone/Fax

Practice location:
  • Phone: 630-837-9000
  • Fax: 630-540-3927
Mailing address:
  • Phone: 224-213-5265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number178.004959
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number35158
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: