Provider Demographics
NPI:1508129909
Name:LANGE, REBECCA SUE (LMSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:LANGE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 N. DELIA ST.
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431
Mailing Address - Country:US
Mailing Address - Phone:231-425-4325
Mailing Address - Fax:231-425-4036
Practice Address - Street 1:503 S JAMES ST
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2325
Practice Address - Country:US
Practice Address - Phone:231-425-4036
Practice Address - Fax:231-425-4036
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI60810911371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical