Doctor Name: | MARY KATHLEEN LANGE |
NPI Number: | 1427477371 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. |
License Number: | |
Business Practice Address: | 6084 Thornapple Dr Greendale, WI - 531292641 |
Business Phone Number: | 4142387152 |
Business Fax Number: | |
Mailing Address: | 6084 Thornapple Dr, GREENDALE |
State: | WI |
Postal Code: | 531292641 |
Phone Number: | 4142387152 |
Fax Number: | |
NPI Enumeration Date: | 04/08/2014 |
NPI Last Update Date: | 04/08/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |