Provider Demographics
NPI:1740304690
Name:PURKETT, YOLANDA RENEE (LSW)
Entity type:Individual
Prefix:MISS
First Name:YOLANDA
Middle Name:RENEE
Last Name:PURKETT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 W 105TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2530
Mailing Address - Country:US
Mailing Address - Phone:773-928-1154
Mailing Address - Fax:
Practice Address - Street 1:328 W 105TH PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2530
Practice Address - Country:US
Practice Address - Phone:773-928-1154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker