Individual
BETH LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
105 N 5TH AVE, MADILL, OK 73446-1203
(580) 795-3301
(580) 795-7307
Mailing address
PO BOX 831, MADILL, OK 73446-0831
(580) 795-3301
(580) 795-7307
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1030
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100641040D
—
OK
Enumeration date
08/31/2006
Last updated
07/09/2007
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