MEDICARE: MICHELLE ROXANNE LABRECQUE M.A. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	5109	CT

General Provider Information

NPI Number	:	1295189272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ROXANNE LABRECQUE M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	77 PLYMOUTH RD
Second Line	:
City	:	HARWINTON
State	:	CT
Zip	:	06791-2420
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 MAIN ST N
Second Line	:
City	:	SOUTHBURY
State	:	CT
Zip	:	06488-1267
Country	:	US
Telephone Number	:	203-264-9135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2016
Last Update Date	:	04/15/2016

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Directions to “ MICHELLE ROXANNE LABRECQUE M.A. CCC-SLP” Practice Location

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