Provider Demographics
NPI:1285943738
Name:REUTER, TABITHA JEAN (SLP)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:JEAN
Last Name:REUTER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51103-3508
Mailing Address - Country:US
Mailing Address - Phone:712-560-4838
Mailing Address - Fax:712-560-3902
Practice Address - Street 1:1301 W 1ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103-3508
Practice Address - Country:US
Practice Address - Phone:712-560-4838
Practice Address - Fax:712-560-3902
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1503487Medicaid
NE100264593-00Medicaid
NE100264595-00Medicaid
NE100264591-00Medicaid