Provider Demographics
NPI:1033176649
Name:BAKER-LANGE, KATHERINE MICHELLE (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:MICHELLE
Last Name:BAKER-LANGE
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3281 CRANE ST
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4603
Mailing Address - Country:US
Mailing Address - Phone:952-233-2636
Mailing Address - Fax:
Practice Address - Street 1:3800 PARK NICOLLET BLVD
Practice Address - Street 2:PARK NICOLLET CLINIC CANCER CENTER
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2527
Practice Address - Country:US
Practice Address - Phone:952-993-1902
Practice Address - Fax:952-993-2810
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS