MEDICARE: YVONNE D. ANDERSON LCSW, CADC, MISA II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	20911	IL
2	1041C0700X	Clinical Social Worker		IL

General Provider Information

NPI Number	:	1023016565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE D. ANDERSON LCSW, CADC, MISA II

Provider Business Mailing Address
First Line	:	2625 BUTTERFIELD RD
Second Line	:	SUITE 101W
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1234
Country	:	US
Telephone Number	:	630-574-2010
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 BUTTERFIELD RD
Second Line	:	SUITE 101W
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1234
Country	:	US
Telephone Number	:	630-574-2010
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	09/11/2025

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