Provider Demographics
NPI:1174251029
Name:HAILE, LANE (SLPA)
Entity type:Individual
Prefix:MISS
First Name:LANE
Middle Name:
Last Name:HAILE
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 KINGSLAND CT
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6221
Mailing Address - Country:US
Mailing Address - Phone:707-971-0832
Mailing Address - Fax:
Practice Address - Street 1:5030 BUSINESS CENTER DR STE 245
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-6909
Practice Address - Country:US
Practice Address - Phone:707-681-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62022355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant