Healthcare Provider Details

I. General information

NPI: 1225948672
Provider Name (Legal Business Name): OLIVIA JEANNE LANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 COMMERCE RD
WEST BLOOMFIELD MI
48324-2717
US

IV. Provider business mailing address

6611 COMMERCE RD
WEST BLOOMFIELD MI
48324-2717
US

V. Phone/Fax

Practice location:
  • Phone: 248-266-1221
  • Fax: 248-771-1221
Mailing address:
  • Phone: 248-266-1221
  • Fax: 248-771-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7152001436
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: