MEDICARE: KIMBERLY DAWN LANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2004028839	MO

General Provider Information

NPI Number	:	1437897576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DAWN LANG

Provider Business Mailing Address
First Line	:	6402 PROSPECT PLAZA
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6402 PROSPECT PLAZA
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119
Country	:	US
Telephone Number	:	816-321-5250
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	05/26/2022

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Directions to “ KIMBERLY DAWN LANG ” Practice Location

Language	Start Address	Practice Location

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