Healthcare Provider Details

I. General information

NPI: 1689160558
Provider Name (Legal Business Name): TRICIA SYBESMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 10/12/2021
Certification Date: 10/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 W PRATT BLVD APT 2E
CHICAGO IL
60626-5647
US

IV. Provider business mailing address

1324 W PRATT BLVD APT 2E
CHICAGO IL
60626-5647
US

V. Phone/Fax

Practice location:
  • Phone: 773-251-7418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149020449
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: