Provider Demographics
NPI:1891779815
Name:KOBARA-MATES, MINDY SAYO (PHD, CCC-SP)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:SAYO
Last Name:KOBARA-MATES
Suffix:
Gender:F
Credentials:PHD, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9441 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60203-1310
Mailing Address - Country:US
Mailing Address - Phone:847-674-9702
Mailing Address - Fax:847-674-9702
Practice Address - Street 1:9441 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60203-1310
Practice Address - Country:US
Practice Address - Phone:847-674-9702
Practice Address - Fax:847-674-9702
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist