Individual
MARLENE RUBY IBARRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8335 E KELLOGG DR, WICHITA, KS 67207-1839
(316) 711-7135
Mailing address
2400 W SAINT LOUIS ST, WICHITA, KS 67203-5114
(316) 214-3822
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12439-T
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12439-T
LICENSED MASTERS SOCIAL WORKER-TEMPORARY
KS
Enumeration date
03/21/2022
Last updated
03/21/2022
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