Provider Demographics
NPI:1700024601
Name:WEBSTER, TAMARA (MS,, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:WEBSTER
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 1:1676 SUNSET AVE
Mailing Address - Street 2:FAXTON ST. LUKE'S HEALTHCARE
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5475
Mailing Address - Country:US
Mailing Address - Phone:315-624-5455
Mailing Address - Fax:
Practice Address - Street 1:1676 SUNSET AVE
Practice Address - Street 2:FAXTON ST. LUKE'S HEALTHCARE
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5475
Practice Address - Country:US
Practice Address - Phone:315-624-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist