Healthcare Provider Details

I. General information

NPI: 1124688874
Provider Name (Legal Business Name): TERRA LABENZ M.S. ED, CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2019
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 CENTENNIAL CIR
NORTH PLATTE NE
69101-6586
US

IV. Provider business mailing address

PO BOX 212
SUTHERLAND NE
69165-0212
US

V. Phone/Fax

Practice location:
  • Phone: 308-534-7000
  • Fax:
Mailing address:
  • Phone: 402-705-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number712
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2432
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: