Individual
DEBBIE SUSAN IBRAHIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,CCC-SLP
Contact information
Practice address
1315 WALNUT ST, TEXARKANA, TX 75501-4446
(903) 794-2705
Mailing address
3001 WALNUT ST, TEXARKANA, TX 75503-3738
(903) 794-2705
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
01103843
—
235Z00000X
Speech-Language Pathologist
Primary
16598
TX
235Z00000X
Speech-Language Pathologist
SP#921
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82608
ARBCBS
AR
01
—
8T1288
BCBSTX
TX
Enumeration date
11/10/2006
Last updated
07/09/2007
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