Provider Demographics
NPI:1407310881
Name:TIBBETTS, ELEANOR CLOE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ELEANOR
Middle Name:CLOE
Last Name:TIBBETTS
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 1:7103 4TH ST. NW CHATTERBOX SPEECH THERAPY
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107
Mailing Address - Country:US
Mailing Address - Phone:505-821-1638
Mailing Address - Fax:505-821-5107
Practice Address - Street 1:7103 4TH ST. NW CHATTERBOX SPEECH THERAPY
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107
Practice Address - Country:US
Practice Address - Phone:505-821-1638
Practice Address - Fax:505-821-5107
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP6356235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist