Provider Demographics
NPI:1316158546
Name:LASTER, JAN (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:
Last Name:LASTER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 CROSSPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-9362
Mailing Address - Country:US
Mailing Address - Phone:859-689-1577
Mailing Address - Fax:
Practice Address - Street 1:5942 N ORIENT ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-9739
Practice Address - Country:US
Practice Address - Phone:859-334-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2452235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist