Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 4293 | OH |
N | 103T00000X | Psychologist | 4293 | OH |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 4293 | OH |
Y | 103G00000X | Clinical Psychologist | 4293 | OH |
Y | 103TC0700X | Clinical Psychologist | 4293 | OH |
NPI | 1154463297 |
---|---|
Provider Name | Dr. Shirley Jo Lange |
First Address | Worthington, OH 43085-2316 |
Second Address | Worthington, OH 43085-2316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 21/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0840648 | (05) | OH |