Basic Information
| Provider Information | |||||||||
| NPI: | 1952391880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YASKOFF | ||||||||
| FirstName: | TANYA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | ATC, PES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3017 N CLIFTON AVE | ||||||||
| Address2: | #2 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606574333 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1145 N HARLEM AVE | ||||||||
| Address2: | |||||||||
| City: | OAK PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 603021529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083862086 | ||||||||
| FaxNumber: | 7083863028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.