Healthcare Provider Details

I. General information

NPI: 1619740529
Provider Name (Legal Business Name): BILLI ALEXANDRIA HYLAND AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALI HYLAND AUD

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5758 S MARYLAND AVE
CHICAGO IL
60637-1426
US

IV. Provider business mailing address

5835 S COTTAGE GROVE AVE # DCAM4H
CHICAGO IL
60637-1416
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-1865
  • Fax:
Mailing address:
  • Phone: 773-702-1220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147.001906
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: