Provider Demographics
NPI:1518192020
Name:ZAMBIASI, TABATHA (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TABATHA
Middle Name:
Last Name:ZAMBIASI
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:TABATHA
Other - Middle Name:
Other - Last Name:TYSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 TROUBLE LN
Mailing Address - Street 2:
Mailing Address - City:FALLING WATERS
Mailing Address - State:WV
Mailing Address - Zip Code:25419-6952
Mailing Address - Country:US
Mailing Address - Phone:304-279-6997
Mailing Address - Fax:
Practice Address - Street 1:216 TROUBLE LN
Practice Address - Street 2:
Practice Address - City:FALLING WATERS
Practice Address - State:WV
Practice Address - Zip Code:25419-6952
Practice Address - Country:US
Practice Address - Phone:304-279-6997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist