Provider Demographics
NPI:1396285888
Name:IBE, EZENWANYI C (CCC-A/SLP)
Entity type:Individual
Prefix:DR
First Name:EZENWANYI
Middle Name:C
Last Name:IBE
Suffix:
Gender:F
Credentials:CCC-A/SLP
Other - Prefix:
Other - First Name:EZENWANYI
Other - Middle Name:C
Other - Last Name:ONWUZURUOHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21077 KINGSLAND BLVD APT 6217
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3267
Mailing Address - Country:US
Mailing Address - Phone:770-866-5024
Mailing Address - Fax:
Practice Address - Street 1:21077 KINGSLAND BLVD APT 6217
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3267
Practice Address - Country:US
Practice Address - Phone:770-866-5024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119730235Z00000X
TX81534231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist