Provider Demographics
NPI:1700921566
Name:CHIBUCOS, THOMAS ALEXANDER (MS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALEXANDER
Last Name:CHIBUCOS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N HAMPDEN CT
Mailing Address - Street 2:#24D
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1869
Mailing Address - Country:US
Mailing Address - Phone:773-818-3491
Mailing Address - Fax:773-524-2686
Practice Address - Street 1:2700 N HAMPDEN CT
Practice Address - Street 2:#24D
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1869
Practice Address - Country:US
Practice Address - Phone:773-818-3491
Practice Address - Fax:773-524-2686
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
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