Provider Demographics
NPI:1548346190
Name:LAKE, MARGARET J (NBC-HIS)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:J
Last Name:LAKE
Suffix:
Gender:F
Credentials:NBC-HIS
Other - Prefix:MRS
Other - First Name:PAT
Other - Middle Name:
Other - Last Name:DRONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AUD
Mailing Address - Street 1:1640 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-3636
Mailing Address - Country:US
Mailing Address - Phone:563-326-5441
Mailing Address - Fax:563-326-5441
Practice Address - Street 1:1640 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-3636
Practice Address - Country:US
Practice Address - Phone:563-326-5441
Practice Address - Fax:563-326-5441
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA350237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0259606Medicaid
IA0935718Medicaid