MEDICARE: SUSAN TRACY LAINE MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2202004156	VA

General Provider Information

NPI Number	:	1306109715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN TRACY LAINE MS

Provider Business Mailing Address
First Line	:	1708 OTTERDALE RD
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-6914
Country	:	US
Telephone Number	:	804-402-4254
Fax Number	:

Provider Business Practice Location Address
First Line	:	1708 OTTERDALE RD
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-6914
Country	:	US
Telephone Number	:	804-402-4254
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2012
Last Update Date	:	01/20/2026

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Directions to “ SUSAN TRACY LAINE MS” Practice Location

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