Provider Demographics
NPI:1790307544
Name:LABRECQUE, MARYBETH (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:LABRECQUE
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 1:67 KNOX RD
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-3809
Mailing Address - Country:US
Mailing Address - Phone:603-715-2044
Mailing Address - Fax:
Practice Address - Street 1:300 BELANGER DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NH
Practice Address - Zip Code:03275-3258
Practice Address - Country:US
Practice Address - Phone:603-485-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0942235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist