Provider Demographics
NPI:1538464367
Name:LANG, DELORES
Entity Type:Individual
Prefix:MRS
First Name:DELORES
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60484-3323
Mailing Address - Country:US
Mailing Address - Phone:708-534-8105
Mailing Address - Fax:708-534-8107
Practice Address - Street 1:628 CLOVER LN
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:IL
Practice Address - Zip Code:60484-3323
Practice Address - Country:US
Practice Address - Phone:708-534-8105
Practice Address - Fax:708-534-8107
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst