Provider Demographics
NPI:1104318997
Name:LANE, JEFFERY JR (AUD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:LANE
Suffix:JR
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 S WOODLANDS VILLAGE BLVD STE 300-409
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-7114
Mailing Address - Country:US
Mailing Address - Phone:928-522-0500
Mailing Address - Fax:855-433-1122
Practice Address - Street 1:1330 N RIM DR STE B
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3138
Practice Address - Country:US
Practice Address - Phone:928-522-0500
Practice Address - Fax:855-433-1122
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist