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NPI Code Detail

MEDICARE: MS. KIMBERLY RENEE LANGSTON LCSW

MEDICARE: MS. KIMBERLY RENEE LANGSTON LCSW
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
1103T00000XPsychologistIL 149011122IL
21041C0700XClinical Social Worker149011122IL

General Provider Information

NPI Number : 1700910304
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY RENEE LANGSTON LCSW
Provider Business Mailing Address
First Line : 2910 W 98TH ST
Second Line :
City : EVERGREEN PARK
State : IL
Zip : 60805-2618
Country : US
Telephone Number : 773-439-0984
Fax Number :
Provider Business Practice Location Address
First Line : 10725 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60643-3217
Country : US
Telephone Number : 773-439-0984
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2007
Last Update Date : 01/05/2023

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