Provider Demographics
NPI:1427892264
Name:LA BELLE, RIVER J (HAS)
Entity type:Individual
Prefix:MR
First Name:RIVER
Middle Name:J
Last Name:LA BELLE
Suffix:
Gender:M
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 BALDWIN PINES CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-7400
Mailing Address - Country:US
Mailing Address - Phone:774-810-0332
Mailing Address - Fax:
Practice Address - Street 1:2 ROPER CORNERS CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4833
Practice Address - Country:US
Practice Address - Phone:864-999-0261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHAS-0753237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist