Provider Demographics
NPI:1972966257
Name:JABURI, ISMAHAN II
Entity Type:Individual
Prefix:
First Name:ISMAHAN
Middle Name:
Last Name:JABURI
Suffix:II
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABDULKARIM
Other - Middle Name:ALI
Other - Last Name:ADEN
Other - Suffix:II
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 271382
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-1382
Mailing Address - Country:US
Mailing Address - Phone:801-503-2306
Mailing Address - Fax:
Practice Address - Street 1:3471 S HEDRON PL APT 601
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-7910
Practice Address - Country:US
Practice Address - Phone:801-503-2306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-03
Last Update Date:2016-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT971767119012355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant