Provider Demographics
NPI:1053820829
Name:LANG, TAMARA LEAH (MA)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:LEAH
Last Name:LANG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4822 SUNSET TERRACE
Mailing Address - Street 2:APRT D
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628
Mailing Address - Country:US
Mailing Address - Phone:530-588-1566
Mailing Address - Fax:
Practice Address - Street 1:800 S HAM LN
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3543
Practice Address - Country:US
Practice Address - Phone:209-368-7141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist