Provider Demographics
NPI:1306987615
Name:RIDDLE-HEBB, SHARON (AUD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:RIDDLE-HEBB
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2091
Mailing Address - Fax:423-857-2012
Practice Address - Street 1:105 W STONE DR
Practice Address - Street 2:STE 4D
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3256
Practice Address - Country:US
Practice Address - Phone:423-392-6299
Practice Address - Fax:423-392-6920
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNA261231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508626Medicaid
TN103I086169Medicare UPIN
TN3192058Medicare UPIN
TN1508626Medicaid