Provider Demographics
NPI:1952552820
Name:LANGLAND, SALLY J (CSAC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:J
Last Name:LANGLAND
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:J
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSAC
Mailing Address - Street 1:N3482 LANGLAND RD
Mailing Address - Street 2:
Mailing Address - City:SARONA
Mailing Address - State:WI
Mailing Address - Zip Code:54870-9324
Mailing Address - Country:US
Mailing Address - Phone:715-469-3308
Mailing Address - Fax:
Practice Address - Street 1:N3482 LANGLAND RD
Practice Address - Street 2:
Practice Address - City:SARONA
Practice Address - State:WI
Practice Address - Zip Code:54870-9324
Practice Address - Country:US
Practice Address - Phone:715-469-3308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39373500Medicaid