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General NPI Number Information
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NPI Number | 1093000788
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Entity Type | Individual
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Provider Name | SCOTT LANG SAC-IT
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Gender | Male
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Dates
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Enumeration Date | 06/10/2011
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Last Update Date | 06/10/2011
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Provider Practice Location Address
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Address Line | 6040 W LISBON AVE 102
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City | MILWAUKEE
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State | WI
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Zip | 53210-2116
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Country | US
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Telephone | 414-454-6707
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Fax |
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Provider Business Mailing Address
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Address Line | 3008 W STATE ST 5
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City | MILWAUKEE
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State | WI
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Zip | 53208-3403
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 16290-130
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License Number State | WI
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