Provider Demographics
NPI:1992067433
Name:BECKER, SYLVIA
Entity type:Individual
Prefix:MS
First Name:SYLVIA
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 S YORK RD
Mailing Address - Street 2:
Mailing Address - City:BENSENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60106-3471
Mailing Address - Country:US
Mailing Address - Phone:630-531-3358
Mailing Address - Fax:888-888-8888
Practice Address - Street 1:1043 S YORK RD
Practice Address - Street 2:
Practice Address - City:BENSENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60106-3471
Practice Address - Country:US
Practice Address - Phone:630-531-3358
Practice Address - Fax:888-888-8888
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180003114OtherILLINOIS DEPT. OF PROFESSIONAL REGULATION
IL5641OtherIAODAPCA