Provider Demographics
NPI:1336875368
Name:IRBY, DIVANTE GEE'COLDBE
Entity Type:Individual
Prefix:
First Name:DIVANTE
Middle Name:GEE'COLDBE
Last Name:IRBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12732 SILLIMAN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-3402
Mailing Address - Country:US
Mailing Address - Phone:225-683-5922
Mailing Address - Fax:
Practice Address - Street 1:12732 SILLIMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722-3402
Practice Address - Country:US
Practice Address - Phone:225-683-5922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant