Healthcare Provider Details

I. General information

NPI: 1194324053
Provider Name (Legal Business Name): IRINA SALABAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 STONEGATE RD STE 102
ALGONQUIN IL
60102-5614
US

IV. Provider business mailing address

758 BUFFALO CIR
CAROL STREAM IL
60188-9106
US

V. Phone/Fax

Practice location:
  • Phone: 224-232-7482
  • Fax: 779-220-2389
Mailing address:
  • Phone: 630-309-4140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277002021
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number209022128
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: