Provider Demographics
NPI:1174008122
Name:CROUCH, YOLANDA
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:
Last Name:CROUCH
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 1:5322 N FRANCISCO AVE APT GN
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-4035
Mailing Address - Country:US
Mailing Address - Phone:773-647-6196
Mailing Address - Fax:
Practice Address - Street 1:2424 40TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7215
Practice Address - Country:US
Practice Address - Phone:309-553-9050
Practice Address - Fax:888-243-3903
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180012611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty