Provider Demographics
NPI:1114284627
Name:DEBELA-SLEDGE, HURUBE
Entity Type:Individual
Prefix:MS
First Name:HURUBE
Middle Name:
Last Name:DEBELA-SLEDGE
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 1:7334 S UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-2018
Mailing Address - Country:US
Mailing Address - Phone:562-256-7550
Mailing Address - Fax:562-256-7540
Practice Address - Street 1:7334 S UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-2018
Practice Address - Country:US
Practice Address - Phone:562-256-7550
Practice Address - Fax:562-256-7540
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2298224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2298Medicaid
CA2298Medicare PIN