Provider Demographics
NPI:1881002657
Name:LANGE, KATIE (BCBA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 24TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-3404
Mailing Address - Country:US
Mailing Address - Phone:239-272-1080
Mailing Address - Fax:239-596-2210
Practice Address - Street 1:8344 LAUREL LAKES BLVD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-9792
Practice Address - Country:US
Practice Address - Phone:239-877-7734
Practice Address - Fax:239-596-2210
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-13-13317103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst