Provider Demographics
NPI:1164015608
Name:PAN, YU
Entity Type:Individual
Prefix:
First Name:YU
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 W MADISON ST APT 2904
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2479
Mailing Address - Country:US
Mailing Address - Phone:872-806-7837
Mailing Address - Fax:
Practice Address - Street 1:300 W ADAMS ST STE 514
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-5108
Practice Address - Country:US
Practice Address - Phone:312-578-9990
Practice Address - Fax:312-275-7663
Is Sole Proprietor?:No
Enumeration Date:2021-02-16
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016391101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional