Provider Demographics
NPI:1063542629
Name:LANE, COURTNEY L (MSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
Last Name:LANE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57757 PEAR RD.
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46619
Mailing Address - Country:US
Mailing Address - Phone:574-876-8697
Mailing Address - Fax:
Practice Address - Street 1:300 N MICHIGAN ST
Practice Address - Street 2:SUITE 420
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1295
Practice Address - Country:US
Practice Address - Phone:574-291-9300
Practice Address - Fax:574-291-9301
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker