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General NPI Number Information
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NPI Number | 1457934762
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Entity Type | Individual
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Provider Name | DEIDRA L BIBBS M.A.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2021
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Last Update Date | 05/04/2021
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Provider Practice Location Address
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Address Line | 3700 W KILGORE AVE
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City | MUNCIE
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State | IN
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Zip | 47304-4810
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Country | US
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Telephone | 765-289-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 9087 CLEVELAND CT APT 202
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City | MERRILLVILLE
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State | IN
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Zip | 46410-0018
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Country | US
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Telephone | 773-294-2528
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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