1356644793 NPI number — DR. LAUREL LYNN LANGHOLZ PH.D.

Table of content: DR. LAUREL LYNN LANGHOLZ PH.D. (NPI 1356644793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356644793 NPI number — DR. LAUREL LYNN LANGHOLZ PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANGHOLZ
Provider First Name:
LAUREL
Provider Middle Name:
LYNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356644793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1930 SAINT ANDREWS CT NE STE D
Provider Second Line Business Mailing Address:
STE 309
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52402-5832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-320-3211
Provider Business Mailing Address Fax Number:
319-237-7345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1930 SAINT ANDREWS CT NE STE D
Provider Second Line Business Practice Location Address:
STE 309
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52402-5832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-320-3211
Provider Business Practice Location Address Fax Number:
319-237-7345
Provider Enumeration Date:
12/07/2010

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: 103T00000X , with the licence number:  001165 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 12259001 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com