Provider Demographics
NPI:1386837383
Name:SIEBERT, TAMARA SUE (SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:SUE
Last Name:SIEBERT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 N DAVID ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-5436
Mailing Address - Country:US
Mailing Address - Phone:316-773-9391
Mailing Address - Fax:
Practice Address - Street 1:3511 E 73RD CIR N
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67147-9235
Practice Address - Country:US
Practice Address - Phone:316-214-5416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2470235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist