Provider Demographics
NPI:1124688874
Name:LABENZ, TERRA (MS ED, CF-SLP)
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:
Last Name:LABENZ
Suffix:
Gender:F
Credentials:MS ED, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 212
Mailing Address - Street 2:
Mailing Address - City:SUTHERLAND
Mailing Address - State:NE
Mailing Address - Zip Code:69165-0212
Mailing Address - Country:US
Mailing Address - Phone:402-705-3537
Mailing Address - Fax:
Practice Address - Street 1:510 CENTENNIAL CIR
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6586
Practice Address - Country:US
Practice Address - Phone:308-534-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-15
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE712235Z00000X
NE2432235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist