Healthcare Provider Details

I. General information

NPI: 1013502103
Provider Name (Legal Business Name): ARIELLE M LANER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 03/02/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 GRAND AVE
OAKLAND CA
94610
US

IV. Provider business mailing address

5662 MAXWELTON RD
PIEDMONT CA
94618-2653
US

V. Phone/Fax

Practice location:
  • Phone: 510-250-9199
  • Fax:
Mailing address:
  • Phone: 510-407-1785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA6379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: