Provider Demographics
NPI:1306490511
Name:LABROSCIANO, TERA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:TERA
Middle Name:
Last Name:LABROSCIANO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:TERA
Other - Middle Name:
Other - Last Name:KOKOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:780 CAPTIVA CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8507
Mailing Address - Country:US
Mailing Address - Phone:951-847-5909
Mailing Address - Fax:
Practice Address - Street 1:30588 VIA LAKISTAS
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-6976
Practice Address - Country:US
Practice Address - Phone:951-847-5909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10604235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist