Provider Demographics
NPI:1265625164
Name:BEAUCHAMP, LANE RENE (MSW)
Entity type:Individual
Prefix:MS
First Name:LANE
Middle Name:RENE
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 ROY WAY
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-8924
Mailing Address - Country:US
Mailing Address - Phone:907-283-0653
Mailing Address - Fax:907-283-0653
Practice Address - Street 1:460 ROY WAY
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-8924
Practice Address - Country:US
Practice Address - Phone:907-283-0653
Practice Address - Fax:907-283-0653
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management