Provider Demographics
NPI:1669624524
Name:IBARRA, MARJORIE S (SLP)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:S
Last Name:IBARRA
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 1:8121 RAINBOW BLVD NW
Mailing Address - Street 2:TIERRA ANTIGUA ES
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6192
Mailing Address - Country:US
Mailing Address - Phone:505-792-3262
Mailing Address - Fax:
Practice Address - Street 1:8121 RAINBOW BLVD NW
Practice Address - Street 2:TIERRA ANTIGUA ES
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6192
Practice Address - Country:US
Practice Address - Phone:505-792-3262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC 4389235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNONE ASSIGNEDMedicaid