MEDICARE: SYBIL MATHAI ALEX CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	1460006841	IL

General Provider Information

NPI Number	:	1104947134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYBIL MATHAI ALEX CCC-SLP

Provider Business Mailing Address
First Line	:	460 COVENTRY CIR
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-4517
Country	:	US
Telephone Number	:	630-408-0603
Fax Number	:	630-547-8510

Provider Business Practice Location Address
First Line	:	460 COVENTRY CIR
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-4517
Country	:	US
Telephone Number	:	630-408-0603
Fax Number	:	630-547-8510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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