Provider Information for 1396380929
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EDILBERTO SISON BIBAT Jr. LCPC
Sex: Male
NPI: 1396380929
Last Updated: 2019-11-06
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1396380929 | ||||||||
| Enumeration Date | 2019-11-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1217 EUCLID AVE WHITING, IN 46394-1507 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 1585 ELLINWOOD AVE # STL11 DES PLAINES, IL 60016-4510 United States Phone: 847-525-4254 | Fax: | ||||||||
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