Healthcare Provider Details

I. General information

NPI: 1043335466
Provider Name (Legal Business Name): IBTISAM RAHIMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 159TH ST.
OAK FOREST IL
60452
US

IV. Provider business mailing address

10621 NORTHBRIDGE CT
ORLAND PARK IL
60462-1323
US

V. Phone/Fax

Practice location:
  • Phone: 708-535-0933
  • Fax: 708-614-9435
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: