Provider Demographics
NPI:1932311024
Name:DRAKE, LILIANNE J (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LILIANNE
Middle Name:J
Last Name:DRAKE
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 1:501 S RANCHO DR
Mailing Address - Street 2:SUITE I-60
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4838
Mailing Address - Country:US
Mailing Address - Phone:702-598-1622
Mailing Address - Fax:702-598-1696
Practice Address - Street 1:501 S RANCHO DR
Practice Address - Street 2:SUITE I-60
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4838
Practice Address - Country:US
Practice Address - Phone:702-598-1622
Practice Address - Fax:702-598-1696
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-357235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3402163Medicaid