Provider Demographics
NPI:1225152853
Name:LANE, BARBARA DEE (SLP)
Entity Type:Individual
Prefix:MISS
First Name:BARBARA
Middle Name:DEE
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 1:3230 RIVER LODGE TRL S
Mailing Address - Street 2:#819
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-0847
Mailing Address - Country:US
Mailing Address - Phone:817-731-9085
Mailing Address - Fax:
Practice Address - Street 1:701 AMERICAN FLYER BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-4687
Practice Address - Country:US
Practice Address - Phone:817-367-1370
Practice Address - Fax:817-367-1371
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist