Provider Demographics
NPI:1477793651
Name:LANG, CHERYL LYNETTE (MA, CCC-SP)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNETTE
Last Name:LANG
Suffix:
Gender:F
Credentials:MA, CCC-SP
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LANG
Other - Last Name:KENDRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1365 BAGLEY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-1004
Mailing Address - Country:US
Mailing Address - Phone:313-963-6230
Mailing Address - Fax:
Practice Address - Street 1:1365 BAGLEY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-1004
Practice Address - Country:US
Practice Address - Phone:313-963-6230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12012651235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist