Yvonne Licavoli
Counselor, Professional in Swansea, IL. Individual provider (NPI-1).
NPI number1760113005
StatusActive
Last updated in NPPESJun 17, 2022
Details
- NPI
- 1760113005
- Entity type
- Individual (NPI-1)
- Name
- Yvonne Licavoli
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 17, 2022
- Certification date
- Jun 17, 2022
- Last updated
- Jun 17, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YP2500X | Counselor, Professional | 178015261 | IL | Yes |
Practice location
4509 N Illinois St Ste 4Swansea, IL 62226-1524
Phone 314-669-5060
Mailing address
9626 Ridge Heights RdFairview Heights, IL 62208-2319
Phone 314-397-1428
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