Provider Demographics
NPI:1134523129
Name:LANGE, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:LANGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 LARKIN RD
Mailing Address - Street 2:APT. 249
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2504 LARKIN RD
Practice Address - Street 2:APT. 249
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3209
Practice Address - Country:US
Practice Address - Phone:859-245-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid