Individual
VICKI L LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1600 W CHANDLER BLVD STE 110, CHANDLER, AZ 85224-6100
(415) 296-5290
(415) 296-5299
Mailing address
7300 E INDIANA ST STE 103, EVANSVILLE, IN 47715-7448
(812) 473-0181
(812) 473-5822
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20040842A
IN
103T00000X
Psychologist
Primary
PSY-005255
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000247634
ANTHEM
IN
05
—
100437960
—
IN
Enumeration date
11/29/2006
Last updated
08/08/2024
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