Provider Demographics
NPI:1376520031
Name:YATES, BONNIE C (LCPC RN MAC CRADC)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:C
Last Name:YATES
Suffix:
Gender:F
Credentials:LCPC RN MAC CRADC
Other - Prefix:MS
Other - First Name:BONNIE
Other - Middle Name:ELEANOR
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCPC RN MAC CRADC
Mailing Address - Street 1:217 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-2018
Mailing Address - Country:US
Mailing Address - Phone:847-551-1217
Mailing Address - Fax:847-551-9692
Practice Address - Street 1:217 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST DUNDEE
Practice Address - State:IL
Practice Address - Zip Code:60118-2018
Practice Address - Country:US
Practice Address - Phone:847-551-1217
Practice Address - Fax:847-551-9692
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101Y00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
N4U91OtherMAGELLAN & EMPIRE BLUE CR
04508001OtherBLUE CROSS BLUE SHIELD