Provider Demographics
NPI:1407177629
Name:SEIBALD, CARLY BETH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:BETH
Last Name:SEIBALD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 COUNTY ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-4208
Mailing Address - Country:US
Mailing Address - Phone:914-439-4456
Mailing Address - Fax:
Practice Address - Street 1:1517 COUNTY ROUTE 28
Practice Address - Street 2:
Practice Address - City:VALATIE
Practice Address - State:NY
Practice Address - Zip Code:12184-4208
Practice Address - Country:US
Practice Address - Phone:914-439-4456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020397235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist