Individual
EMMA LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP/L
Contact information
Practice address
112 HEATHERVIEW DR, EAST PEORIA, IL 61611-4889
(309) 360-0707
Mailing address
1109 EKSTAM DR APT 105, BLOOMINGTON, IL 61704-3319
(309) 678-6202
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14041640
IL
Other
Enumeration date
05/01/2013
Last updated
05/01/2013
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