Individual
MS. SAMANTHA LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1046 HILLSIDE ROAD, GROVE, OK 74344
(918) 801-8681
Mailing address
1046 HILLSIDE RD, GROVE, OK 74344-3514
(918) 801-8681
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3144
OK
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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