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General NPI Number Information
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NPI Number | 1689787624
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Entity Type | Individual
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Provider Name | JILL SUZANNE LANE MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 5451 DAVIE ROAD
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City | DAVIE
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State | FL
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Zip | 33314
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Country | US
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Telephone | 954-290-4277
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Fax | 954-584-7816
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Provider Business Mailing Address
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Address Line | 995 SW 147 AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33027
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Country | US
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Telephone | 954-290-4277
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Fax | 954-584-7816
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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 | SA7798
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License Number State | FL
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