Healthcare Provider Details

I. General information

NPI: 1376096032
Provider Name (Legal Business Name): RAENA ROSALIE SYBERS MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13413 NE LEROY HAGEN MEMORIAL DR
VANCOUVER WA
98684-5967
US

IV. Provider business mailing address

13413 NE LEROY HAGEN MEMORIAL DR
VANCOUVER WA
98684-5967
US

V. Phone/Fax

Practice location:
  • Phone: 360-604-4000
  • Fax:
Mailing address:
  • Phone: 360-604-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15852
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberLL61356758
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: