Provider Demographics
NPI:1134656291
Name:FANOUS, LANA ELAINE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:ELAINE
Last Name:FANOUS
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25812 W 69TH TER
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66226-3349
Mailing Address - Country:US
Mailing Address - Phone:913-687-8344
Mailing Address - Fax:
Practice Address - Street 1:7251 W 20TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4625
Practice Address - Country:US
Practice Address - Phone:970-702-2998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program