Provider Demographics
NPI:1740627629
Name:LAKE, ELAINE M (AUD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:LAKE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:M
Other - Last Name:LAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:6650 W 110TH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1501
Mailing Address - Country:US
Mailing Address - Phone:913-521-9090
Mailing Address - Fax:913-521-9955
Practice Address - Street 1:6650 W 110TH ST STE 330
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211-1501
Practice Address - Country:US
Practice Address - Phone:913-521-9090
Practice Address - Fax:913-521-9955
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014031706231H00000X
KS1639237700000X
KS2268231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist