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General NPI Number Information
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NPI Number | 1437605946
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Entity Type | Individual
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Provider Name | COURTNEY LANE M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/26/2016
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 8875 OAK GROVE RD
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City | FORT WORTH
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State | TX
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Zip | 76140-5135
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Country | US
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Telephone | 737-867-0498
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Fax |
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Provider Business Mailing Address
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Address Line | 224 LINCOLN LN
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City | CROWLEY
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State | TX
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Zip | 76036-4016
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Country | US
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Telephone | 512-797-3438
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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 | 272136
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP 24547
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 107228
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License Number State | TX
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