Provider Demographics
NPI:1184390346
Name:CIBRIAN, THERESA A
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:CIBRIAN
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 1:700 WELLINGTON AVE UNIT 518
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-7333
Mailing Address - Country:US
Mailing Address - Phone:773-226-1209
Mailing Address - Fax:
Practice Address - Street 1:1001 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-2054
Practice Address - Country:US
Practice Address - Phone:847-692-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146011581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist