Provider Demographics
NPI:1306033212
Name:LANGE, VANESSA KAMAL (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:KAMAL
Last Name:LANGE
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CATESBY LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-4535
Mailing Address - Country:US
Mailing Address - Phone:561-271-6729
Mailing Address - Fax:
Practice Address - Street 1:59 CATESBY LN
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-4535
Practice Address - Country:US
Practice Address - Phone:561-271-6729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04951235Z00000X
NH1170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist