Provider Demographics
NPI:1376932608
Name:VAN BOVEN, LANA
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:VAN BOVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14730 23RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7307
Mailing Address - Country:US
Mailing Address - Phone:206-920-9767
Mailing Address - Fax:
Practice Address - Street 1:14730 23RD AVE NE
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-7307
Practice Address - Country:US
Practice Address - Phone:206-920-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASLPI.SI.60532119235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist