Healthcare Provider Details

I. General information

NPI: 1093824625
Provider Name (Legal Business Name): BRITTANY KAVANAUGH LANE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 FOREST MARSH DRIVE
NEPTUNE BEACH FL
32266-6405
US

IV. Provider business mailing address

1425 FOREST MARSH DR
NEPTUNE BEACH FL
32266-6405
US

V. Phone/Fax

Practice location:
  • Phone: 352-284-7601
  • Fax:
Mailing address:
  • Phone: 352-284-7601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA7676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: