Provider Demographics
NPI:1295853778
Name:AVILA, YOLANDA FLOR (CDS, M ED)
Entity Type:Individual
Prefix:MS
First Name:YOLANDA
Middle Name:FLOR
Last Name:AVILA
Suffix:
Gender:F
Credentials:CDS, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608
Mailing Address - Country:US
Mailing Address - Phone:312-208-0228
Mailing Address - Fax:312-491-8431
Practice Address - Street 1:1421 W 16TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608
Practice Address - Country:US
Practice Address - Phone:312-208-0228
Practice Address - Fax:312-491-8431
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILYA87140801P225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist