Provider Demographics
NPI:1568774016
Name:LANG, KATHY (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 E MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-4817
Mailing Address - Country:US
Mailing Address - Phone:407-896-6686
Mailing Address - Fax:
Practice Address - Street 1:1462 E MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4817
Practice Address - Country:US
Practice Address - Phone:407-896-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS 571103TS0200X
FLSA 9441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool