Provider Demographics
NPI:1336710219
Name:SALAH, HIBA
Entity Type:Individual
Prefix:
First Name:HIBA
Middle Name:
Last Name:SALAH
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 1:1820 S 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60155-3960
Mailing Address - Country:US
Mailing Address - Phone:708-681-0073
Mailing Address - Fax:
Practice Address - Street 1:17324 AVON LN
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-2203
Practice Address - Country:US
Practice Address - Phone:708-465-2068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health