Provider Demographics
NPI:1962643999
Name:JEANNE YAKIN LTD
Entity Type:Organization
Organization Name:JEANNE YAKIN LTD
Other - Org Name:IVY TESTING ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:YAKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-342-0266
Mailing Address - Street 1:500 LAKE COOK RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5609
Mailing Address - Country:US
Mailing Address - Phone:847-597-7047
Mailing Address - Fax:847-282-5001
Practice Address - Street 1:500 LAKE COOK RD
Practice Address - Street 2:SUITE 350
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5609
Practice Address - Country:US
Practice Address - Phone:847-597-7047
Practice Address - Fax:847-282-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-21
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007436103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty