Provider Demographics
NPI:1942452909
Name:LEPAGE, MONIQUE DORIS (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:DORIS
Last Name:LEPAGE
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 1:69 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPLAIN
Mailing Address - State:NY
Mailing Address - Zip Code:12919-5202
Mailing Address - Country:US
Mailing Address - Phone:518-298-3180
Mailing Address - Fax:518-298-3180
Practice Address - Street 1:69 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CHAMPLAIN
Practice Address - State:NY
Practice Address - Zip Code:12919-5202
Practice Address - Country:US
Practice Address - Phone:518-298-3180
Practice Address - Fax:518-298-3180
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009923-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist