Provider Demographics
NPI:1356569347
Name:SEIBOLD, ROZ (HIS)
Entity type:Individual
Prefix:
First Name:ROZ
Middle Name:
Last Name:SEIBOLD
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1603
Mailing Address - Country:US
Mailing Address - Phone:520-327-0882
Mailing Address - Fax:520-327-6205
Practice Address - Street 1:4570 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1638
Practice Address - Country:US
Practice Address - Phone:520-690-2075
Practice Address - Fax:520-292-0251
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4300237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist