Healthcare Provider Details

I. General information

NPI: 1376353359
Provider Name (Legal Business Name): ISABELLA E LABONTE SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 01/10/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 HIGHWAY 80 E STE 3
CLINTON MS
39056-4726
US

IV. Provider business mailing address

921 W BEACON ST
PHILADELPHIA MS
39350-3229
US

V. Phone/Fax

Practice location:
  • Phone: 601-460-0910
  • Fax:
Mailing address:
  • Phone: 601-650-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberS5220
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: