Provider Demographics
NPI:1750593257
Name:LANG, LINDA JOAN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:JOAN
Last Name:LANG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 E DOHMEN DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-9381
Mailing Address - Country:US
Mailing Address - Phone:928-310-8892
Mailing Address - Fax:
Practice Address - Street 1:1569 SILVERWOOD DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-5357
Practice Address - Country:US
Practice Address - Phone:925-817-7916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP7069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist