Provider Demographics
NPI:1619171493
Name:LANE, RHONDA LANE (MACCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:LANE
Last Name:LANE
Suffix:
Gender:F
Credentials:MACCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 POINT COMFORT LN
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9435
Mailing Address - Country:US
Mailing Address - Phone:706-210-3698
Mailing Address - Fax:
Practice Address - Street 1:3615 POINT COMFORT LN
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-9435
Practice Address - Country:US
Practice Address - Phone:706-210-3698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004870235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist