Provider Demographics
NPI:1104947134
Name:ALEX, SYBIL MATHAI (CCC-SLP)
Entity type:Individual
Prefix:
First Name:SYBIL
Middle Name:MATHAI
Last Name:ALEX
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 COVENTRY CIR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-4517
Mailing Address - Country:US
Mailing Address - Phone:630-408-0603
Mailing Address - Fax:630-547-8510
Practice Address - Street 1:460 COVENTRY CIR
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-4517
Practice Address - Country:US
Practice Address - Phone:630-408-0603
Practice Address - Fax:630-547-8510
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1460006841235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist