Provider Demographics
NPI:1982579413
Name:PHILLIPS, SYLVIA (MT-BC)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 EISENHOWER RD
Mailing Address - Street 2:
Mailing Address - City:MASCOUTAH
Mailing Address - State:IL
Mailing Address - Zip Code:62258-1607
Mailing Address - Country:US
Mailing Address - Phone:708-310-6234
Mailing Address - Fax:
Practice Address - Street 1:1305 EISENHOWER RD
Practice Address - Street 2:
Practice Address - City:MASCOUTAH
Practice Address - State:IL
Practice Address - Zip Code:62258-1607
Practice Address - Country:US
Practice Address - Phone:708-310-6234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist