Provider Demographics
NPI:1306966288
Name:IHM, PATRICIA LYNN (MSED, CIMI)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:IHM
Suffix:
Gender:F
Credentials:MSED, CIMI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-4126
Mailing Address - Country:US
Mailing Address - Phone:815-748-7516
Mailing Address - Fax:815-787-7053
Practice Address - Street 1:706 S 3RD ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4126
Practice Address - Country:US
Practice Address - Phone:815-748-7516
Practice Address - Fax:815-787-7053
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPI64691100P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist