Healthcare Provider Details

I. General information

NPI: 1164919106
Provider Name (Legal Business Name): TABETHA ANN KEBBEKUS M.S., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TABETHA ANN SCHROEDER

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W NORTH AVE
MILWAUKEE WI
53208-1448
US

IV. Provider business mailing address

W359S1687 HWY 67
DOUSMAN WI
53118-8902
US

V. Phone/Fax

Practice location:
  • Phone: 414-874-3600
  • Fax:
Mailing address:
  • Phone: 262-719-2249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7531-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: