Provider Demographics
NPI:1013152560
Name:HUMBERT, IANESSA ALICIA (PHD)
Entity type:Individual
Prefix:DR
First Name:IANESSA
Middle Name:ALICIA
Last Name:HUMBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:IANESSA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4641 MONTGOMERY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3430
Mailing Address - Country:US
Mailing Address - Phone:240-472-1051
Mailing Address - Fax:844-983-2008
Practice Address - Street 1:4641 MONTGOMERY AVE STE 300
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3430
Practice Address - Country:US
Practice Address - Phone:240-472-1051
Practice Address - Fax:844-983-2008
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist