Provider Demographics
NPI:1265216394
Name:GLEASON, TABITHA LEE (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:LEE
Last Name:GLEASON
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:LEE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2820 COLLEGE AVE APT 316
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6140
Mailing Address - Country:US
Mailing Address - Phone:479-966-5153
Mailing Address - Fax:
Practice Address - Street 1:400 N VANCOUVER AVE
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2750
Practice Address - Country:US
Practice Address - Phone:479-968-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist