Healthcare Provider Details

I. General information

NPI: 1205520657
Provider Name (Legal Business Name): ELIZABETH ZIBARA M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 06/07/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10020 FERRY RD
GROSSE ILE MI
48138-1654
US

IV. Provider business mailing address

10020 FERRY RD
GROSSE ILE MI
48138-1654
US

V. Phone/Fax

Practice location:
  • Phone: 734-985-8500
  • Fax:
Mailing address:
  • Phone: 734-985-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101005091
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: