Provider Demographics
NPI:1588899967
Name:SIEBERS, JUDITH MARIE
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:MARIE
Last Name:SIEBERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 ACADIA WAY
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-7400
Mailing Address - Country:US
Mailing Address - Phone:217-224-0949
Mailing Address - Fax:
Practice Address - Street 1:3119 ACADIA WAY
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-7400
Practice Address - Country:US
Practice Address - Phone:217-224-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.000281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist