Provider Demographics
NPI:1801043492
Name:TEBBE, DEANNA SUE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:SUE
Last Name:TEBBE
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 1:12112 OILFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:BARTELSO
Mailing Address - State:IL
Mailing Address - Zip Code:62218-1531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:618-594-8826
Practice Address - Street 1:13978 OIL FIELD RD
Practice Address - Street 2:
Practice Address - City:BARTELSO
Practice Address - State:IL
Practice Address - Zip Code:62218-1002
Practice Address - Country:US
Practice Address - Phone:618-765-2413
Practice Address - Fax:618-594-8826
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.008650235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist