Provider Information for 1205110780
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Dr. YVETTE MEDINA LCPC, CADC, CAMS II
Sex: Female
NPI: 1205110780
Last Updated: 2023-01-11
Certification Date: 2023-01-11
Certification Date: 2023-01-11
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1205110780 | ||||||||
| Enumeration Date | 2011-10-03 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 3244 W BEACH AVE 2ND FLOOR CHICAGO, IL 60651-2431 United States Phone: 312-320-2198 | Fax: | ||||||||
| Primary Practice Address | 1240 EUCLID AVE FL 2 BERWYN, IL 60402-1005 United States Phone: 773-951-0046 | Fax: | ||||||||
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