1992132849 NPI number — YAKOS THERAPY PC

Table of content: (NPI 1992132849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992132849 NPI number — YAKOS THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YAKOS THERAPY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
YAKOS THERAPY INC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992132849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 E COURT ST STE 708
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANKAKEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60901-3845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-304-5548
Provider Business Mailing Address Fax Number:
815-304-5548

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 E COURT ST STE 708
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANKAKEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60901-3845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-304-5548
Provider Business Practice Location Address Fax Number:
815-304-5548
Provider Enumeration Date:
10/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
YAKOS
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
SPEECH-LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
815-304-5548

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  146011221 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1194260794 . This is a "PRIVATE HEALTH INSURANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1093288904 . This is a "PRIVATE HEALTH INSURANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1871874826 . This is a "PRIVATE HEALTH INSURANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1700346327 . This is a "PRIVATE HEALTH INSURANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1972069730 . This is a "PRIVATE HEALTH INSURANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1588837710 . This is a "PRIVATE HEALTH INSURANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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