Provider Demographics
NPI:1043355852
Name:IBARGUEN, ANICA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANICA
Middle Name:
Last Name:IBARGUEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12605 EAST FWY STE 212
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77015-5619
Mailing Address - Country:US
Mailing Address - Phone:713-453-0400
Mailing Address - Fax:713-453-0408
Practice Address - Street 1:12605 EAST FWY STE 212
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77015-5619
Practice Address - Country:US
Practice Address - Phone:713-453-0400
Practice Address - Fax:713-453-0408
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist