Provider Demographics
NPI:1912071176
Name:RIALS, LANE ROBERTS (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:ROBERTS
Last Name:RIALS
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 1:4530 NELSON BROGDON BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-5407
Mailing Address - Country:US
Mailing Address - Phone:678-820-9606
Mailing Address - Fax:844-820-9616
Practice Address - Street 1:4530 NELSON BROGDON BLVD STE C
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518
Practice Address - Country:US
Practice Address - Phone:678-820-9606
Practice Address - Fax:844-820-9616
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET001077235Z00000X
235Z00000X
GASLP006547235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist