Provider Demographics
NPI:1588807713
Name:LAYNE, LARA CARTER (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LARA
Middle Name:CARTER
Last Name:LAYNE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1698 W HIBISCUS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2639
Mailing Address - Country:US
Mailing Address - Phone:321-768-6119
Mailing Address - Fax:
Practice Address - Street 1:1698 W HIBISCUS BLVD STE A
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2639
Practice Address - Country:US
Practice Address - Phone:321-768-6119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist