Provider Demographics
NPI:1780866442
Name:COFFER, LANA HORTON (MED,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:HORTON
Last Name:COFFER
Suffix:
Gender:F
Credentials:MED,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 WAKE FOREST BUSINESS PARK STE D
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-7184
Mailing Address - Country:US
Mailing Address - Phone:919-556-1700
Mailing Address - Fax:
Practice Address - Street 1:833 WAKE FOREST BUSINESS PARK STE D
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-7184
Practice Address - Country:US
Practice Address - Phone:919-556-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7795235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist