Provider Demographics
NPI:1154589984
Name:EUSEBIO, IDYL L (AUD)
Entity type:Individual
Prefix:
First Name:IDYL
Middle Name:L
Last Name:EUSEBIO
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 W HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-4217
Mailing Address - Country:US
Mailing Address - Phone:773-878-0365
Mailing Address - Fax:
Practice Address - Street 1:7447 W TALCOTT AVE STE 316
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3714
Practice Address - Country:US
Practice Address - Phone:773-467-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001241231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist