Individual
LINDA LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
130 HOWARD LN, FAYETTEVILLE, GA 30215-1849
(770) 460-0165
Mailing address
220 MANOR DR, FAYETTEVILLE, GA 30215-7618
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP001609
GA
Other
Enumeration date
03/15/2007
Last updated
07/08/2007
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