Healthcare Provider Details

I. General information

NPI: 1093056277
Provider Name (Legal Business Name): LOUISE LANGDON LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 12/03/2022
Certification Date: 12/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 9TH ST
ANN ARBOR MI
48103-4202
US

IV. Provider business mailing address

114 9TH ST
ANN ARBOR MI
48103-4202
US

V. Phone/Fax

Practice location:
  • Phone: 734-709-2628
  • Fax: 734-822-0077
Mailing address:
  • Phone: 734-709-2628
  • Fax: 734-822-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6361006224
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: