Provider Demographics
NPI:1831246495
Name:LANE, KATHLEEN ANNE (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:KATHLEEN
Middle Name:ANNE
Last Name:LANE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4439 MULLENS FORD RD APT C
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-4016
Mailing Address - Country:US
Mailing Address - Phone:704-576-8446
Mailing Address - Fax:704-598-3024
Practice Address - Street 1:3403 LINDEN BERRY LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-1300
Practice Address - Country:US
Practice Address - Phone:704-258-1724
Practice Address - Fax:704-598-3024
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7459235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist