Provider Demographics
NPI:1952463622
Name:HEINS, YVONNE R (PHD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:R
Last Name:HEINS
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 1:4101 JARVIS
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOE
Mailing Address - State:IL
Mailing Address - Zip Code:60712
Mailing Address - Country:US
Mailing Address - Phone:847-763-9907
Mailing Address - Fax:847-763-9907
Practice Address - Street 1:2518 N. LINCOLN
Practice Address - Street 2:SUITE 204
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:847-763-9907
Practice Address - Fax:847-763-9907
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
526850Medicare ID - Type Unspecified