MEDICARE: MRS. JENNIFER LEE LABESKY-WALTERS B.A.

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	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1326207523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LEE LABESKY-WALTERS B.A.

Provider Business Mailing Address
First Line	:	231 SE BARRINGTON DR
Second Line	:	SUITE 202
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-3200
Country	:	US
Telephone Number	:	360-279-1905
Fax Number	:	360-279-9459

Provider Business Practice Location Address
First Line	:	231 SE BARRINGTON DR
Second Line	:	SUITE 202
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-3200
Country	:	US
Telephone Number	:	360-279-1905
Fax Number	:	360-279-9459

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

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/03/2008

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