Provider Demographics
NPI:1477813491
Name:PANNIYOTH VALIYA, PARAMBATHU CYNTHIA NAMBIAR
Entity Type:Individual
Prefix:
First Name:PARAMBATHU
Middle Name:CYNTHIA NAMBIAR
Last Name:PANNIYOTH VALIYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:NAMBIAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP,CCC
Mailing Address - Street 1:440 N WABASH AVE
Mailing Address - Street 2:APT 3802
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3549
Mailing Address - Country:US
Mailing Address - Phone:857-207-6659
Mailing Address - Fax:
Practice Address - Street 1:440 N WABASH AVE
Practice Address - Street 2:APT 3802
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3549
Practice Address - Country:US
Practice Address - Phone:857-207-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.010953235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist