Provider Demographics
NPI:1568459766
Name:LANG, MAUREEN THERESA (MA CCCA)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:THERESA
Last Name:LANG
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:MISS
Other - First Name:MAUREEN
Other - Middle Name:THERESA
Other - Last Name:STRYKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75-5591 PALANI RD
Mailing Address - Street 2:#206
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3631
Mailing Address - Country:US
Mailing Address - Phone:808-329-0943
Mailing Address - Fax:808-329-0943
Practice Address - Street 1:75-5591 PALANI RD
Practice Address - Street 2:#206
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3631
Practice Address - Country:US
Practice Address - Phone:808-329-0943
Practice Address - Fax:808-329-0943
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAUD91231H00000X
HIHA112237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI55491600OtherALOHA CARE
HIAUD91OtherMDX
HI0000249490OtherHMSA
HI521527OtherHMN/HMA
HI55491601Medicaid
HI57082Medicare ID - Type Unspecified