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NPI Code Detail

MEDICARE: LAYNE JEFFREY DEBARDELABEN SP

MEDICARE: LAYNE JEFFREY DEBARDELABEN SP
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
1235Z00000XSpeech-Language Pathologist16797TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
182603TOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1396816575
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAYNE JEFFREY DEBARDELABEN SP
Provider Business Mailing Address
First Line : 4101 S MEDFORD DR
Second Line :
City : LUFKIN
State : TX
Zip : 75901-5633
Country : US
Telephone Number : 936-639-1141
Fax Number : 936-633-5695
Provider Business Practice Location Address
First Line : 4101 S MEDFORD DR
Second Line :
City : LUFKIN
State : TX
Zip : 75901-5633
Country : US
Telephone Number : 936-639-1141
Fax Number : 936-633-5695
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2006
Last Update Date : 07/09/2007

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Directions to “ LAYNE JEFFREY DEBARDELABEN SP” Practice Location

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