Individual
MARY VERONICA LABERGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
705 HARRISON ST, LA PORTE, IN 46350-3417
(219) 229-0109
Mailing address
705 HARRISON ST, LA PORTE, IN 46350-3417
(219) 229-0109
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22004438A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22004438A
STATE LICENSE
IN
Enumeration date
09/06/2017
Last updated
07/21/2022
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