Provider Demographics
NPI:1447907688
Name:LABELLE, SUSAN M
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:LABELLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3178 HAMPSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60087-5328
Mailing Address - Country:US
Mailing Address - Phone:847-372-1531
Mailing Address - Fax:
Practice Address - Street 1:3178 HAMPSHIRE LN
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60087-5328
Practice Address - Country:US
Practice Address - Phone:847-372-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist