Provider Demographics
NPI:1043943608
Name:SEIBERT, ELIZABETH WILLIAMS (SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WILLIAMS
Last Name:SEIBERT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:STREET
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:921 W. BEACON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-3229
Mailing Address - Country:US
Mailing Address - Phone:601-650-0002
Mailing Address - Fax:601-650-9902
Practice Address - Street 1:2653 WEST OXFORD LOOP
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5442
Practice Address - Country:US
Practice Address - Phone:662-715-3045
Practice Address - Fax:662-715-3046
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012117235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist