Healthcare Provider Details

I. General information

NPI: 1841506169
Provider Name (Legal Business Name): SUZANNE TRAN LANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11445 E VIA LINDA STE 2235
SCOTTSDALE AZ
85259-2655
US

IV. Provider business mailing address

7918 W FRANK AVE
PEORIA AZ
85382-4481
US

V. Phone/Fax

Practice location:
  • Phone: 602-403-5220
  • Fax:
Mailing address:
  • Phone: 360-259-9154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA6825
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: