Individual
CARMEN LYNNETTE TIBBS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED., CDS, DT, SLPA
Contact information
Practice address
65 W 152ND PL, REAR HOUSE, SOUTH HOLLAND, IL 60473-1002
(708) 539-1565
(708) 746-4389
Mailing address
65 W 152ND PL, REAR HOUSE, SOUTH HOLLAND, IL 60473-1002
(708) 539-1565
(708) 746-4389
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
CT32520898P
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CT32520898P
PART C EI CREDENTIAL
IL
Enumeration date
06/05/2007
Last updated
07/08/2007
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