Individual
SUSAN TRACY LAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
1708 OTTERDALE RD, MIDLOTHIAN, VA 23114-6914
(804) 402-4254
Mailing address
1708 OTTERDALE RD, MIDLOTHIAN, VA 23114-6914
(804) 402-4254
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202004156
VA
Other
Enumeration date
06/20/2012
Last updated
01/20/2026
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