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General NPI Number Information
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NPI Number | 1518455567
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Entity Type | Individual
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Provider Name | FAE BABETTE LAFORTE MFT
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Gender | Female
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Dates
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Enumeration Date | 04/25/2018
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Last Update Date | 04/25/2018
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Provider Practice Location Address
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Address Line | 1316 E PROSPECT ST
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City | DURAND
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State | WI
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Zip | 54736-1517
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Country | US
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Telephone | 715-672-3746
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Fax |
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Provider Business Mailing Address
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Address Line | N7471 537TH ST
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City | MENOMONIE
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State | WI
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Zip | 54751-5904
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Country | US
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Telephone | 715-672-3746
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 634-228
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License Number State | WI
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