Provider Demographics
NPI:1619488004
Name:LEBEIS, CAROLYN MICHELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MICHELLE
Last Name:LEBEIS
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:MICHELLE
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:92 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7228
Mailing Address - Country:US
Mailing Address - Phone:207-797-5753
Mailing Address - Fax:
Practice Address - Street 1:92 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7228
Practice Address - Country:US
Practice Address - Phone:207-797-5753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2522235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist