Provider Demographics
NPI:1417598889
Name:KORBAKES, ALEXA B (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:B
Last Name:KORBAKES
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 N PINE GROVE AVE APT 400
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6130
Mailing Address - Country:US
Mailing Address - Phone:847-975-8202
Mailing Address - Fax:
Practice Address - Street 1:1551 LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5651
Practice Address - Country:US
Practice Address - Phone:847-374-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.005557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist