Provider Demographics
NPI:1376013136
Name:OMAR, LUBNA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LUBNA
Middle Name:
Last Name:OMAR
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 1:5784 JOSHUA ST
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1154
Mailing Address - Country:US
Mailing Address - Phone:563-271-1950
Mailing Address - Fax:
Practice Address - Street 1:5784 JOSHUA ST
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1154
Practice Address - Country:US
Practice Address - Phone:563-271-1950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004832235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist