Individual
DANA MARIE TIEBOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
247 RHODES RD, TOLLAND, CT 06084-3568
(860) 870-6750
Mailing address
43 CRYSTAL RIDGE DR, TOLLAND, CT 06084-2165
(203) 804-4355
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
004894
CT
235Z00000X
Speech-Language Pathologist
9516
MA
Other
Enumeration date
12/10/2015
Last updated
08/15/2023
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