Provider Demographics
NPI:1659545408
Name:LYBOLT, JOHN T (CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:T
Last Name:LYBOLT
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:900 SKOKIE BLVD
Mailing Address - Street 2:SUITE NUMBER 215
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-4012
Mailing Address - Country:US
Mailing Address - Phone:847-564-9230
Mailing Address - Fax:847-564-9258
Practice Address - Street 1:900 SKOKIE BLVD
Practice Address - Street 2:SUITE NUMBER 215
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4012
Practice Address - Country:US
Practice Address - Phone:847-564-9230
Practice Address - Fax:847-564-9258
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146003355235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist