Provider Demographics
NPI:1275368896
Name:LANE, VERONICA ELIZABETH (AUD)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:ELIZABETH
Last Name:LANE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 DEMPSTER ST STE 301
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1127
Mailing Address - Country:US
Mailing Address - Phone:847-685-1000
Mailing Address - Fax:
Practice Address - Street 1:1875 DEMPSTER ST STE 301
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1127
Practice Address - Country:US
Practice Address - Phone:847-685-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.002014231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist