Provider Demographics
NPI:1093329765
Name:LABORN, EMMA E (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:E
Last Name:LABORN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:
Other - Last Name:BRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2624 S WINSTON AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-4851
Mailing Address - Country:US
Mailing Address - Phone:713-449-7675
Mailing Address - Fax:
Practice Address - Street 1:14002 E 21ST ST # 650
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74134-1425
Practice Address - Country:US
Practice Address - Phone:918-274-7902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14342604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist