Provider Demographics
NPI:1396973343
Name:LANE, LYNNE S (MA/CCCS)
Entity type:Individual
Prefix:MRS
First Name:LYNNE
Middle Name:S
Last Name:LANE
Suffix:
Gender:F
Credentials:MA/CCCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06907-1733
Mailing Address - Country:US
Mailing Address - Phone:203-253-6839
Mailing Address - Fax:203-323-9599
Practice Address - Street 1:124 KNAPP ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06907-1733
Practice Address - Country:US
Practice Address - Phone:203-253-6839
Practice Address - Fax:203-323-9599
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000156235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist