MEDICARE: JODI LANE M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA14083	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275082844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI LANE M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	950 S KANNER HWY
Second Line	:	APT D5
City	:	STUART
State	:	FL
Zip	:	34994-3709
Country	:	US
Telephone Number	:	561-674-1639
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 MERCER AVE
Second Line	:	#10
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-7441
Country	:	US
Telephone Number	:	561-371-3277
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2016
Last Update Date	:	09/23/2016

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