Provider Demographics
NPI:1063048536
Name:LEGORRETA HERNANDEZ, JUDITH YANCIRI
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:YANCIRI
Last Name:LEGORRETA HERNANDEZ
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 1:105 BURNSIDE CT
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1403
Mailing Address - Country:US
Mailing Address - Phone:847-544-9515
Mailing Address - Fax:
Practice Address - Street 1:721 S QUENTIN RD STE 103
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-6778
Practice Address - Country:US
Practice Address - Phone:847-359-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-17
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional