Provider Demographics
NPI:1710741913
Name:MILEJCZAK, YVONNE (IMH22574)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:MILEJCZAK
Suffix:
Gender:F
Credentials:IMH22574
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N HIGHWAY 27 STE 4
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2411
Mailing Address - Country:US
Mailing Address - Phone:352-708-6283
Mailing Address - Fax:
Practice Address - Street 1:210 N HIGHWAY 27 STE 4
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2411
Practice Address - Country:US
Practice Address - Phone:352-708-6283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22574101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health