Basic Information
Provider Information
NPI: 1003018318
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SEYBERT
FirstName: AMBER
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1123 ROCKDALE AVE
Address2:  
City: NEW BEDFORD
State: MA
PostalCode: 027402947
CountryCode: US
TelephoneNumber: 5089977448
FaxNumber:  
Practice Location
Address1: 1123 ROCKDALE AVE
Address2:  
City: NEW BEDFORD
State: MA
PostalCode: 027402947
CountryCode: US
TelephoneNumber: 5089977448
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/31/2007
LastUpdateDate: 01/14/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000XSA8276FLN Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 
235Z00000X6680MAY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

No ID Information.


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