Provider Demographics
NPI:1891006169
Name:LANGER, ELISSA BETSY (LAC, MSOM)
Entity Type:Individual
Prefix:MRS
First Name:ELISSA
Middle Name:BETSY
Last Name:LANGER
Suffix:
Gender:F
Credentials:LAC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 MONONA DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-3964
Mailing Address - Country:US
Mailing Address - Phone:608-222-0250
Mailing Address - Fax:
Practice Address - Street 1:6041 MONONA DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-3964
Practice Address - Country:US
Practice Address - Phone:608-222-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI614-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist