Provider Demographics
NPI:1093832867
Name:LANGE, MICHA MORGAN (SLP)
Entity Type:Individual
Prefix:MS
First Name:MICHA
Middle Name:MORGAN
Last Name:LANGE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MICHA
Other - Middle Name:MORGAN
Other - Last Name:LAMBERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:3100 APACHE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7404
Mailing Address - Country:US
Mailing Address - Phone:870-336-0238
Mailing Address - Fax:870-336-0239
Practice Address - Street 1:3100 APACHE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7404
Practice Address - Country:US
Practice Address - Phone:870-336-0238
Practice Address - Fax:870-336-0239
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P7961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR158949721Medicaid
AR5A060OtherSPEECH THERAPY