Provider Demographics
NPI:1083945075
Name:LANE, GINGER MAE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:MAE
Last Name:LANE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4208
Mailing Address - Country:US
Mailing Address - Phone:207-596-0863
Mailing Address - Fax:
Practice Address - Street 1:2 FOOTBRIDGE RD
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-7206
Practice Address - Country:US
Practice Address - Phone:207-338-5307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP568235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist