Provider Demographics
NPI:1417165085
Name:LANG, NICOLE R (SLP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:LANG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7113 ROSELAND DR
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3244
Mailing Address - Country:US
Mailing Address - Phone:515-251-8269
Mailing Address - Fax:
Practice Address - Street 1:950 OFFICE PARK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2549
Practice Address - Country:US
Practice Address - Phone:515-224-0979
Practice Address - Fax:515-223-3862
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01496235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist