Provider Demographics
NPI:1669680500
Name:LABANT, MITZI (LAC)
Entity Type:Individual
Prefix:MS
First Name:MITZI
Middle Name:
Last Name:LABANT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:MITZI
Other - Middle Name:LOUISE
Other - Last Name:NORTH LABANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:1545 WAUKEGAN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2166
Mailing Address - Country:US
Mailing Address - Phone:847-901-1800
Mailing Address - Fax:
Practice Address - Street 1:1545 WAUKEGAN RD STE 2
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2166
Practice Address - Country:US
Practice Address - Phone:847-901-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist