Provider Demographics
NPI:1346311750
Name:IBRAHIM, DEBBIE SUSAN (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:SUSAN
Last Name:IBRAHIM
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3738
Mailing Address - Country:US
Mailing Address - Phone:903-794-2705
Mailing Address - Fax:
Practice Address - Street 1:1315 WALNUT ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-4446
Practice Address - Country:US
Practice Address - Phone:903-794-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#921235Z00000X
TX16598235Z00000X
01103843235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR82608OtherARBCBS
TX8T1288OtherBCBSTX