Provider Demographics
NPI:1154085389
Name:SYLVESTRAK, DEBORAH E (LCPC)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:E
Last Name:SYLVESTRAK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15040 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-1065
Mailing Address - Country:US
Mailing Address - Phone:708-721-4476
Mailing Address - Fax:
Practice Address - Street 1:15040 WABASH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-1065
Practice Address - Country:US
Practice Address - Phone:708-721-4476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.003662101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180.003662OtherLCPC