Provider Demographics
NPI:1578685343
Name:SHIRAISHI, YUKIKO (PHD)
Entity Type:Individual
Prefix:DR
First Name:YUKIKO
Middle Name:
Last Name:SHIRAISHI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 LAKE ST
Mailing Address - Street 2:SUITE 807
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1422
Mailing Address - Country:US
Mailing Address - Phone:708-415-7513
Mailing Address - Fax:708-406-1580
Practice Address - Street 1:715 LAKE ST
Practice Address - Street 2:SUITE 807
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1422
Practice Address - Country:US
Practice Address - Phone:708-415-7513
Practice Address - Fax:708-406-1580
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007142103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical