Provider Demographics
NPI:1467098467
Name:LABRECQUE, CAREN ANNE
Entity Type:Individual
Prefix:
First Name:CAREN
Middle Name:ANNE
Last Name:LABRECQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2568 US HIGHWAY 23 S
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-4618
Mailing Address - Country:US
Mailing Address - Phone:989-356-6321
Mailing Address - Fax:989-356-6331
Practice Address - Street 1:2568 US HIGHWAY 23 S
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-4618
Practice Address - Country:US
Practice Address - Phone:989-356-6321
Practice Address - Fax:989-356-6331
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003008225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist