Provider Demographics
NPI:1720477003
Name:LANE, AMBER
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 ELM ST E
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:IA
Mailing Address - Zip Code:50469-1035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 ELM ST E
Practice Address - Street 2:
Practice Address - City:ROCKWELL
Practice Address - State:IA
Practice Address - Zip Code:50469-1035
Practice Address - Country:US
Practice Address - Phone:641-372-0315
Practice Address - Fax:866-610-4384
Is Sole Proprietor?:No
Enumeration Date:2015-01-09
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001680101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health