Provider Demographics
NPI:1063026367
Name:SYME, TABITHA RUTH (MS CF SLP)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:RUTH
Last Name:SYME
Suffix:
Gender:F
Credentials:MS CF SLP
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:500 E GALLOWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672-1422
Mailing Address - Country:US
Mailing Address - Phone:206-931-4796
Mailing Address - Fax:
Practice Address - Street 1:1106 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2130
Practice Address - Country:US
Practice Address - Phone:541-216-5115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR16932OtherBOARD OF EXAMINERS FOR SPEECH-LANGUAGE PATHOLOGY & AUDIOLOGY: STATE LICENSE