Provider Demographics
NPI:1326101072
Name:LEBEAU, LINDA ANN (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:LEBEAU
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 MCARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5961
Mailing Address - Country:US
Mailing Address - Phone:505-463-2790
Mailing Address - Fax:505-645-7065
Practice Address - Street 1:421 MCARTHUR DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5961
Practice Address - Country:US
Practice Address - Phone:505-463-2790
Practice Address - Fax:505-645-7065
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM588235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMD4502Medicaid