Provider Demographics
NPI:1609201045
Name:HERNANDEZ, YOLANDA (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 CONGDON AVE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-2428
Mailing Address - Country:US
Mailing Address - Phone:224-489-4553
Mailing Address - Fax:
Practice Address - Street 1:640 CONGDON AVE
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-2428
Practice Address - Country:US
Practice Address - Phone:224-489-4553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227013794225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist