Provider Demographics
NPI:1205061843
Name:LABARGE, ANN MARIE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:LABARGE
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 1:1903 NEWPORT CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-9204
Mailing Address - Country:US
Mailing Address - Phone:630-308-2628
Mailing Address - Fax:
Practice Address - Street 1:1101 KELLER PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3614
Practice Address - Country:US
Practice Address - Phone:817-562-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104636235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist