Healthcare Provider Details

I. General information

NPI: 1750493623
Provider Name (Legal Business Name): DIANE M LANGER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12607 SE MILL PLAIN BLVD KAISER PERMANENTE CASCADE PARK MEDICAL OFFICE
VANCOUVER WA
98684-6055
US

IV. Provider business mailing address

12607 SE MILL PLAIN BLVD KAISER PERMANENTE CASCADE PARK MEDICAL OFFICE
VANCOUVER WA
98684-6055
US

V. Phone/Fax

Practice location:
  • Phone: 360-896-4460
  • Fax: 360-896-4478
Mailing address:
  • Phone: 360-944-2837
  • Fax: 360-896-4478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00007829
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL3226
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: