Provider Demographics
NPI:1538634514
Name:WETHERINGTON, TABATHA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:
Last Name:WETHERINGTON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15106 ABINGTON RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5270
Mailing Address - Country:US
Mailing Address - Phone:502-548-6662
Mailing Address - Fax:
Practice Address - Street 1:3625 SAINT JOSEPH RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9745
Practice Address - Country:US
Practice Address - Phone:812-948-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY235Z00000X
IN22006933A235Z00000X
NE2800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist