Provider Demographics
NPI:1730461757
Name:LANG, THERESA AHERNE (CCC-SLP/TSHH)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:AHERNE
Last Name:LANG
Suffix:
Gender:F
Credentials:CCC-SLP/TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 PRATT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-7907
Mailing Address - Country:US
Mailing Address - Phone:631-587-3527
Mailing Address - Fax:
Practice Address - Street 1:105 PRATT ST
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-7907
Practice Address - Country:US
Practice Address - Phone:631-587-3527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005141-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist