Provider Demographics
NPI:1629538749
Name:REKIK, IBTISSEM (MS)
Entity Type:Individual
Prefix:MISS
First Name:IBTISSEM
Middle Name:
Last Name:REKIK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MR
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:CICCRELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:355 I ST SW # 6056
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 M ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20024-4019
Practice Address - Country:US
Practice Address - Phone:202-704-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-24
Last Update Date:2020-07-30
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2020-07-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist