Healthcare Provider Details

I. General information

NPI: 1780517334
Provider Name (Legal Business Name): CUTLER J LANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 ROLLING HILL DR
MERIDIAN ID
83642-6722
US

IV. Provider business mailing address

1560 ROLLING HILL DR
MERIDIAN ID
83642-6722
US

V. Phone/Fax

Practice location:
  • Phone: 208-305-0605
  • Fax:
Mailing address:
  • Phone: 208-305-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: