Provider Demographics
NPI:1669766812
Name:LANE, LINDA MARIE CHISHOLM (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:MARIE CHISHOLM
Last Name:LANE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MARIE CHISHOLM
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:6160 E OTERO DR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3028
Mailing Address - Country:US
Mailing Address - Phone:303-771-3123
Mailing Address - Fax:
Practice Address - Street 1:6160 E OTERO DR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3028
Practice Address - Country:US
Practice Address - Phone:303-771-3123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist