Provider Demographics
NPI:1831864453
Name:MANDELBAUM, SABRINA GAIL (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:GAIL
Last Name:MANDELBAUM
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 N ASHLAND AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-7692
Mailing Address - Country:US
Mailing Address - Phone:908-216-3678
Mailing Address - Fax:
Practice Address - Street 1:429 N MARION ST STE 201
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1800
Practice Address - Country:US
Practice Address - Phone:312-945-8305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.014725235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist