Provider Demographics
NPI:1407489727
Name:ATKINS, LANA JEAN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LANA
Middle Name:JEAN
Last Name:ATKINS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 STATE HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63736-9162
Mailing Address - Country:US
Mailing Address - Phone:573-545-3541
Mailing Address - Fax:
Practice Address - Street 1:4035 STATE HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:MO
Practice Address - Zip Code:63736-9162
Practice Address - Country:US
Practice Address - Phone:573-545-3541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009024534235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist