Provider Demographics
NPI:1508391392
Name:LANG, DESIREE A (CPM, LDM)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:A
Last Name:LANG
Suffix:
Gender:F
Credentials:CPM, LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 ASH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2424
Mailing Address - Country:US
Mailing Address - Phone:503-341-6988
Mailing Address - Fax:503-894-6036
Practice Address - Street 1:1735 ASH ST
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-2424
Practice Address - Country:US
Practice Address - Phone:503-341-6988
Practice Address - Fax:503-894-6036
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-28
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
ORDEM-LD-10182719176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife