Individual provider Active NPI

Lane Roberts Rials, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Buford, GA
National Provider Identifier
1912071176
Registry record updated Mar 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SLP006547 Issued in GA
Practice address
4530 Nelson Brogdon Blvd Ste C
Buford, GA 30518
Phone
(678) 820-9606
Fax
(844) 820-9616
NPI assigned
Nov 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X PCET001077 GA
Speech-Language Pathologist 235Z00000X
Speech-Language Pathologist 235Z00000X SLP006547 GA Primary

Addresses

Primary practice location

4530 Nelson Brogdon Blvd Ste C
Buford, GA 30518

Mailing address

4530 Nelson Brogdon Blvd Ste C
Buford, GA 30518-5407
Phone (678) 820-9606

Other practice location 1

3615 Braselton Highway
Suite 103
Dacula, GA 30019-5907
Phone (678) 377-9634

Other practice location 2

3615 Braselton Highway
Suite 103
Dacula, GA 30019-5907
Phone (678) 377-9634

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
PCET001077GAMDSpeech-Language Pathologist
SLP006547GAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Motor Mouth Therapy, LLC Speech-Language Pathologist PastSince Apr 24, 2022 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551744000000",
    "number": "1912071176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4530 NELSON BROGDON BLVD STE C",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305185407",
            "telephone_number": "678-820-9606",
            "fax_number": "844-820-9616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4530 NELSON BROGDON BLVD STE C",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "30518",
            "telephone_number": "678-820-9606",
            "fax_number": "844-820-9616"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3615 Braselton Highway",
            "address_2": "Suite 103",
            "address_purpose": "LOCATION",
            "city": "Dacula",
            "state": "GA",
            "postal_code": "300195907",
            "country_code": "US",
            "telephone_number": "678-377-9634",
            "fax_number": "678-377-9609",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3615 Braselton Highway",
            "address_2": "Suite 103",
            "address_purpose": "LOCATION",
            "city": "Dacula",
            "state": "GA",
            "postal_code": "300195907",
            "country_code": "US",
            "telephone_number": "678-377-9634",
            "fax_number": "678-377-9609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RIALS",
        "first_name": "LANE",
        "middle_name": "ROBERTS",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-20",
        "last_updated": "2019-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "PCET001077",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP006547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buford, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.