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422 N Northwest Hwy Ste 230 Park Ridge IL 60068-3261 | |
| (224) 585-8105 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 422 N Northwest Hwy Ste 230, Park Ridge, Illinois |
| Authorized Official Name and Position | Cynthia L Yesko (OWNER) |
| Authorized Official Contact | 7732513389 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
302 Berry Pkwy Park Ridge IL 60068-4215 Ph: (773) 251-3389 | 422 N Northwest Hwy Ste 230 Park Ridge IL 60068-3261 Ph: (224) 585-8105 |
| NPI Number | 1639929557 |
|---|---|
| Provider Enumeration Date | 03/25/2024 |
| Last Update Date | 06/03/2024 |
| Certification Date | 05/03/2024 |
| Medicare PECOS PAC ID | 1658802624 |
|---|---|
| Medicare Enrollment ID | O20241001002730 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639929557 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Cynthia Lynn Nash Yesko |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1679723811 PECOS PAC ID: 2567993538 Enrollment ID: I20241001002935 |
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