Provider Demographics
NPI:1275188914
Name:SABAIDUC, THEA MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:MARIE
Last Name:SABAIDUC
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27345 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:ROCKBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43149-9796
Mailing Address - Country:US
Mailing Address - Phone:740-603-3357
Mailing Address - Fax:
Practice Address - Street 1:27001 RISCH RD
Practice Address - Street 2:
Practice Address - City:ROCKBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43149-9780
Practice Address - Country:US
Practice Address - Phone:740-603-3357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.13021235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist