Individual
IVANA IBRAHIMOVIC FOSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED, CCC-SLP
Contact information
Practice address
445 104TH AVE, HOLLAND, MI 49423-9107
(616) 795-9693
Mailing address
5870 RICH ST, ALLENDALE, MI 49401-7409
(616) 856-1276
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101000604
MI
Other
Enumeration date
03/01/2021
Last updated
03/01/2021
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