Provider Demographics
NPI:1770990319
Name:GEHRES, LANE HOLIDAY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LANE
Middle Name:HOLIDAY
Last Name:GEHRES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 CYPRESS RUN
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-9184
Mailing Address - Country:US
Mailing Address - Phone:209-365-7479
Mailing Address - Fax:
Practice Address - Street 1:732 CYPRESS RUN
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CA
Practice Address - Zip Code:95258-9184
Practice Address - Country:US
Practice Address - Phone:209-365-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 21368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist