Provider Demographics
NPI:1629774096
Name:PHILIPPAS, CONNIE MARIE
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:MARIE
Last Name:PHILIPPAS
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 1:2223 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2855
Mailing Address - Country:US
Mailing Address - Phone:630-915-6855
Mailing Address - Fax:
Practice Address - Street 1:2223 PINEHURST DR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2855
Practice Address - Country:US
Practice Address - Phone:163-915-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist