Provider Demographics
NPI:1003257387
Name:LANG, CASSANDRA MARIE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:CASSANDRA
Middle Name:MARIE
Last Name:LANG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 N SENECA ST
Mailing Address - Street 2:SUITE 117
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-5937
Mailing Address - Country:US
Mailing Address - Phone:316-259-4382
Mailing Address - Fax:
Practice Address - Street 1:313 N SENECA ST
Practice Address - Street 2:SUITE 117
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-5937
Practice Address - Country:US
Practice Address - Phone:316-259-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW9107104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201076120AMedicaid