Provider Demographics
NPI:1588214332
Name:SITABKHAN, YASMIN
Entity Type:Individual
Prefix:
First Name:YASMIN
Middle Name:
Last Name:SITABKHAN
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 1:133 S GRANT ST
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1907
Mailing Address - Country:US
Mailing Address - Phone:630-258-0043
Mailing Address - Fax:
Practice Address - Street 1:133 S GRANT ST
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1907
Practice Address - Country:US
Practice Address - Phone:630-258-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146012500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist