Healthcare Provider Details

I. General information

NPI: 1093832867
Provider Name (Legal Business Name): MICHA MORGAN LANGE SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHA MORGAN LAMBERSON SLP

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 APACHE DR
JONESBORO AR
72401-7404
US

IV. Provider business mailing address

3100 APACHE DR
JONESBORO AR
72401-7404
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-0238
  • Fax: 870-336-0239
Mailing address:
  • Phone: 870-336-0238
  • Fax: 870-336-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP#P7961
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: