Provider Demographics
NPI:1831861772
Name:LANE, REGAN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:REGAN
Middle Name:
Last Name:LANE
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 1:5015 S REGAL ST APT J3075
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-7947
Mailing Address - Country:US
Mailing Address - Phone:206-406-2328
Mailing Address - Fax:
Practice Address - Street 1:5015 S REGAL ST APT J3075
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-7947
Practice Address - Country:US
Practice Address - Phone:206-406-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61116064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist