Provider Demographics
NPI:1679753883
Name:GARBER, TRICIA LYNN (SLP)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:LYNN
Last Name:GARBER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8517 230TH STREET CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-6545
Mailing Address - Country:US
Mailing Address - Phone:253-655-5007
Mailing Address - Fax:
Practice Address - Street 1:3417 MANASSAS DR
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3208
Practice Address - Country:US
Practice Address - Phone:618-659-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-06
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60108247235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist