Provider Demographics
NPI:1164919106
Name:KEBBEKUS, TABETHA ANN (BS, SLPA)
Entity Type:Individual
Prefix:MRS
First Name:TABETHA
Middle Name:ANN
Last Name:KEBBEKUS
Suffix:
Gender:F
Credentials:BS, SLPA
Other - Prefix:
Other - First Name:TABETHA
Other - Middle Name:ANN
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 S LEANDRO
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-2652
Mailing Address - Country:US
Mailing Address - Phone:262-719-2249
Mailing Address - Fax:
Practice Address - Street 1:225 S LEANDRO
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-2652
Practice Address - Country:US
Practice Address - Phone:262-719-2249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA111562355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant