Provider Demographics
NPI:1902512783
Name:HUANG, YINGJIA
Entity Type:Individual
Prefix:
First Name:YINGJIA
Middle Name:
Last Name:HUANG
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 1:2033 SHERMAN AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3272
Mailing Address - Country:US
Mailing Address - Phone:217-819-0441
Mailing Address - Fax:
Practice Address - Street 1:2033 SHERMAN AVE APT 208
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3272
Practice Address - Country:US
Practice Address - Phone:217-819-0441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150109090104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILXOX808148046OtherBLUECROSSBLUESHIELD