Provider Demographics
NPI:1740890474
Name:IBARRA, LINDSAY CORINNE
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:CORINNE
Last Name:IBARRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2664 TENNYSON ST
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1628
Mailing Address - Country:US
Mailing Address - Phone:805-729-1735
Mailing Address - Fax:
Practice Address - Street 1:1555 SIMI TOWN CENTER WAY STE 720
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-0540
Practice Address - Country:US
Practice Address - Phone:805-416-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant