Provider Demographics
NPI:1023313426
Name:LANZA, CAROL K (MS-CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:K
Last Name:LANZA
Suffix:
Gender:F
Credentials:MS-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6492 BURNIKEL RD
Mailing Address - Street 2:
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-9118
Mailing Address - Country:US
Mailing Address - Phone:715-349-5279
Mailing Address - Fax:
Practice Address - Street 1:210 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LUCK
Practice Address - State:WI
Practice Address - Zip Code:54853-9066
Practice Address - Country:US
Practice Address - Phone:715-472-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI395154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist