Healthcare Provider Details

I. General information

NPI: 1770599532
Provider Name (Legal Business Name): GLORIA ANN LANGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1576 TARA BELLE PKWY
NAPERVILLE IL
60564-8197
US

IV. Provider business mailing address

1576 TARA BELLE PKWY
NAPERVILLE IL
60564-8197
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-9494
  • Fax: 630-978-9494
Mailing address:
  • Phone: 630-978-9494
  • Fax: 630-978-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: