Provider Demographics
NPI:1811277288
Name:LANG, KATHERINE MICHELLE (AU D)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MICHELLE
Last Name:LANG
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 41516
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32203-1516
Mailing Address - Country:US
Mailing Address - Phone:904-202-5111
Mailing Address - Fax:904-391-5836
Practice Address - Street 1:7740 POINT MEADOWS DR STE 7
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9180
Practice Address - Country:US
Practice Address - Phone:904-202-6400
Practice Address - Fax:904-390-7383
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1702231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist