Provider Demographics
NPI:1609154582
Name:LANGE, KATHLEEN R (DT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:LANGE
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 N PINE GROVE AVE
Mailing Address - Street 2:APARTMENT #1E
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3372
Mailing Address - Country:US
Mailing Address - Phone:773-327-8041
Mailing Address - Fax:
Practice Address - Street 1:3919 N PINE GROVE AVE
Practice Address - Street 2:APARTMENT #1E
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3372
Practice Address - Country:US
Practice Address - Phone:773-327-8041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist