Provider Demographics
NPI:1649900705
Name:PHILLIPS, LANA SHAHA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:SHAHA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 S ANDERSON PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-3142
Mailing Address - Country:US
Mailing Address - Phone:808-357-0055
Mailing Address - Fax:
Practice Address - Street 1:1100 W CLARK ST
Practice Address - Street 2:
Practice Address - City:CONNELL
Practice Address - State:WA
Practice Address - Zip Code:99326-9700
Practice Address - Country:US
Practice Address - Phone:509-234-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61407236235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist