Healthcare Provider Details

I. General information

NPI: 1962321364
Provider Name (Legal Business Name): IHSAN YASSMINE ABOUELJOUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUNA ABOUELJOUD

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6816 RIO TEJO WAY
ELK GROVE CA
95757-3432
US

IV. Provider business mailing address

6816 RIO TEJO WAY
ELK GROVE CA
95757-3432
US

V. Phone/Fax

Practice location:
  • Phone: 916-804-7862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: