Healthcare Provider Details

I. General information

NPI: 1356274096
Provider Name (Legal Business Name): JENNIFER LANE M.S., PL-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 COVINGTON CTR
COVINGTON LA
70433-2979
US

IV. Provider business mailing address

110 ZINNIA DR
COVINGTON LA
70433-9121
US

V. Phone/Fax

Practice location:
  • Phone: 985-237-1921
  • Fax:
Mailing address:
  • Phone: 504-441-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number10160
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: