Provider Demographics
NPI:1861658171
Name:LANGE, ROBIN ELENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:ELENA
Last Name:LANGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:ELENA VIVIO
Other - Last Name:SCHWENGELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:164 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-4103
Mailing Address - Country:US
Mailing Address - Phone:801-581-6228
Mailing Address - Fax:
Practice Address - Street 1:164 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-4103
Practice Address - Country:US
Practice Address - Phone:801-581-6228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8456972-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist