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General NPI Number Information
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NPI Number | 1083945075
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Entity Type | Individual
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Provider Name | GINGER MAE LANE M.S. CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 2 FOOTBRIDGE RD
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City | BELFAST
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State | ME
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Zip | 04915-7206
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Country | US
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Telephone | 207-338-5307
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Fax |
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Provider Business Mailing Address
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Address Line | 141 PORTER ST
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City | ROCKPORT
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State | ME
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Zip | 04856-4208
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Country | US
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Telephone | 207-596-0863
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP568
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License Number State | ME
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