Provider Demographics
NPI:1124232962
Name:LANE, KATHRYN D (SLP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:D
Last Name:LANE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 PEMBROKE ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NH
Mailing Address - Zip Code:03275-1361
Mailing Address - Country:US
Mailing Address - Phone:603-485-5187
Mailing Address - Fax:603-485-9529
Practice Address - Street 1:282 BLACK HALL RD
Practice Address - Street 2:
Practice Address - City:EPSOM
Practice Address - State:NH
Practice Address - Zip Code:03234-4353
Practice Address - Country:US
Practice Address - Phone:603-736-9331
Practice Address - Fax:603-736-8703
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0923235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30404579Medicaid