Provider Demographics
NPI:1417489337
Name:ANIFOWOSE, YETUNDE (LPC)
Entity Type:Individual
Prefix:
First Name:YETUNDE
Middle Name:
Last Name:ANIFOWOSE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:YETUNDE
Other - Middle Name:
Other - Last Name:EBIESUWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:433 DODGE AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:433 DODGE AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3253
Practice Address - Country:US
Practice Address - Phone:708-724-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012877101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional