Provider Demographics
NPI:1376096032
Name:SYBERS, RAENA ROSALIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RAENA
Middle Name:ROSALIE
Last Name:SYBERS
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 1:13413 NE LEROY HAGEN MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5967
Mailing Address - Country:US
Mailing Address - Phone:360-604-4000
Mailing Address - Fax:
Practice Address - Street 1:13413 NE LEROY HAGEN MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5967
Practice Address - Country:US
Practice Address - Phone:360-604-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15852235Z00000X
WALL61356758235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist