Healthcare Provider Details

I. General information

NPI: 1871470492
Provider Name (Legal Business Name): SELAH SCHIEBER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 S AUSTIN BLVD
CICERO IL
60804-3139
US

IV. Provider business mailing address

932 W DAKIN ST APT 205
CHICAGO IL
60613-4985
US

V. Phone/Fax

Practice location:
  • Phone: 708-652-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number242.018391
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: