Provider Demographics
NPI:1134446990
Name:LANG, HEIDEMARIE HASSE
Entity type:Individual
Prefix:
First Name:HEIDEMARIE
Middle Name:HASSE
Last Name:LANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:107 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4727
Mailing Address - Country:US
Mailing Address - Phone:434-847-8649
Mailing Address - Fax:
Practice Address - Street 1:107 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4727
Practice Address - Country:US
Practice Address - Phone:434-847-8649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-03
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000678235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00649145OtherAMERICAN SPEECH HEARING ASSOCIATION
VA2202000678OtherBOARD OF AUDIOLOGY AND SPEECH LANGUAGE PATHOLOGY