Provider Demographics
NPI:1366957987
Name:A PLACE FOR SPEECH
Entity type:Organization
Organization Name:A PLACE FOR SPEECH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIEBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC/SLP, CED
Authorized Official - Phone:361-728-9192
Mailing Address - Street 1:PO BOX 271416
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-1416
Mailing Address - Country:US
Mailing Address - Phone:361-334-1136
Mailing Address - Fax:361-334-1574
Practice Address - Street 1:4202 HERMOSA DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4535
Practice Address - Country:US
Practice Address - Phone:361-728-9192
Practice Address - Fax:361-334-1136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty