Provider Demographics
NPI:1750676094
Name:CORMACK-ABOUD, AILBHE T (SLP)
Entity Type:Individual
Prefix:
First Name:AILBHE
Middle Name:T
Last Name:CORMACK-ABOUD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E SCHUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4659
Mailing Address - Country:US
Mailing Address - Phone:915-544-8484
Mailing Address - Fax:915-496-0751
Practice Address - Street 1:1101 E SCHUSTER AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4659
Practice Address - Country:US
Practice Address - Phone:915-544-8484
Practice Address - Fax:915-496-0751
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105973235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist