Provider Demographics
NPI:1285143107
Name:SIEBERT, TAMARA L (MS-CCC/SLP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:SIEBERT
Suffix:
Gender:F
Credentials:MS-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 W FLETCHER ST
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62471-1007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1017 W FLETCHER ST
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:IL
Practice Address - Zip Code:62471-1007
Practice Address - Country:US
Practice Address - Phone:618-283-5166
Practice Address - Fax:618-283-9479
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist