Provider Demographics
NPI:1548576325
Name:LIBBY, LAUREEN (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LAUREEN
Middle Name:
Last Name:LIBBY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 OLD BELFAST RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:ME
Mailing Address - Zip Code:04438-3408
Mailing Address - Country:US
Mailing Address - Phone:207-322-3712
Mailing Address - Fax:
Practice Address - Street 1:577 MOUNT VIEW RD
Practice Address - Street 2:
Practice Address - City:THORNDIKE
Practice Address - State:ME
Practice Address - Zip Code:04986-3307
Practice Address - Country:US
Practice Address - Phone:207-568-4609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1204235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MESP1204OtherMAINECARE