Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | LMSW9107 | KS |
NPI | 1003257387 |
---|---|
Provider Name | Mrs. Cassandra Marie Lang |
First Address | Wichita, KS 67203-5937 |
Second Address | Wichita, KS 67203-5937 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2013 |
Last Update Date | 04/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201076120A | (05) | KS |