Provider Demographics
NPI:1821176744
Name:LANE, THOMAS JEFFERY (MSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JEFFERY
Last Name:LANE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 CENTER POINT RD NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-6571
Mailing Address - Country:US
Mailing Address - Phone:319-378-1199
Mailing Address - Fax:319-378-7497
Practice Address - Street 1:1221 CENTER POINT RD NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-6571
Practice Address - Country:US
Practice Address - Phone:319-378-1199
Practice Address - Fax:319-378-7497
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490091071041C0700X, 1041C0700X
IA0071621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA11867195OtherCAQH