MEDICARE: PRAIRIE VIEW COUNSELING, PLLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1144034406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRAIRIE VIEW COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	900 OGDEN AVE STE 144
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-2829
Country	:	US
Telephone Number	:	640-474-1257
Fax Number	:

Provider Business Practice Location Address
First Line	:	4520 DRENDEL ROAD
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-2421
Country	:	US
Telephone Number	:	640-474-1257
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LCSW
Name	:	TANIA YACKLE
Credential	:	LCSW
Telephone Number	:	630-474-1257

Provider Enumeration Date	:	02/05/2025
Last Update Date	:	07/18/2025

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