Healthcare Provider Details

I. General information

NPI: 1639634660
Provider Name (Legal Business Name): PRISCILLA R LANE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 E FRANKLIN ST
CENTERVILLE OH
45459-5914
US

IV. Provider business mailing address

5400 EDALBERT DR
CINCINNATI OH
45239-7604
US

V. Phone/Fax

Practice location:
  • Phone: 866-534-2639
  • Fax:
Mailing address:
  • Phone: 513-741-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS0019090
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: