Provider Demographics
NPI:1093824625
Name:LANE, BRITTANY KAVANAUGH (MS)
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:KAVANAUGH
Last Name:LANE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 FOREST MARSH DR
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-6405
Mailing Address - Country:US
Mailing Address - Phone:352-284-7601
Mailing Address - Fax:
Practice Address - Street 1:1425 FOREST MARSH DRIVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-6405
Practice Address - Country:US
Practice Address - Phone:352-284-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7676235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist