Healthcare Provider Details

I. General information

NPI: 1033176649
Provider Name (Legal Business Name): KATHERINE MICHELLE BAKER-LANGE M.S, CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 PARK NICOLLET BLVD PARK NICOLLET CLINIC CANCER CENTER
ST LOUIS PARK MN
55416-2527
US

IV. Provider business mailing address

3281 CRANE ST
SHAKOPEE MN
55379-4603
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-1902
  • Fax: 952-993-2810
Mailing address:
  • Phone: 952-233-2636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: