1093832867 NPI number — MS. MICHA MORGAN LANGE SLP

Table of content: MS. MICHA MORGAN LANGE SLP (NPI 1093832867)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093832867 NPI number — MS. MICHA MORGAN LANGE SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGE
Provider First Name:
MICHA
Provider Middle Name:
MORGAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LAMBERSON
Provider Other First Name:
MICHA
Provider Other Middle Name:
MORGAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
SLP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1093832867
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 APACHE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JONESBORO
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72401-7404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-336-0238
Provider Business Mailing Address Fax Number:
870-336-0239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 APACHE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JONESBORO
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72401-7404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-336-0238
Provider Business Practice Location Address Fax Number:
870-336-0239
Provider Enumeration Date:
03/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SP#P7961 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 158949721 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5A060 . This is a "SPEECH THERAPY" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




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