Provider Demographics
NPI:1811255763
Name:LABAROWSKI, KATHLEEN JENDRON (MSP CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:JENDRON
Last Name:LABAROWSKI
Suffix:
Gender:F
Credentials:MSP CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1617 EAGLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7743
Mailing Address - Country:US
Mailing Address - Phone:704-839-9540
Mailing Address - Fax:704-802-4607
Practice Address - Street 1:1617 EAGLE LAKE DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-7743
Practice Address - Country:US
Practice Address - Phone:704-839-9540
Practice Address - Fax:803-802-4607
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-29
Last Update Date:2012-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5642235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist