Provider Demographics
NPI:1316417785
Name:LANE, SHIQUITA LYNNE
Entity type:Individual
Prefix:
First Name:SHIQUITA
Middle Name:LYNNE
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5468 LONGWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-8958
Mailing Address - Country:US
Mailing Address - Phone:800-423-2559
Mailing Address - Fax:
Practice Address - Street 1:520 ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-4240
Practice Address - Country:US
Practice Address - Phone:800-423-2559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst