Provider Demographics
NPI:1649480708
Name:LOERA, YOLANDA V
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:V
Last Name:LOERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 W WHITE ST
Mailing Address - Street 2:APT#152
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-2936
Mailing Address - Country:US
Mailing Address - Phone:217-840-8302
Mailing Address - Fax:
Practice Address - Street 1:70 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3652
Practice Address - Country:US
Practice Address - Phone:217-398-7785
Practice Address - Fax:217-398-7787
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor