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General NPI Number Information
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NPI Number | 1134393515
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Entity Type | Individual
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Provider Name | JO ANN LANGE GRAHAM MSW
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Gender | Female
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 07/23/2010
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Provider Practice Location Address
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Address Line | 1408 N KILLIAN DR STE 202
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City | LAKE PARK
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State | FL
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Zip | 33403-1961
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Country | US
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Telephone | 561-635-4887
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Fax | 561-688-8143
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Provider Business Mailing Address
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Address Line | 1408 NORTH KILLIAN DRIVE
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City | LAKE PARK
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State | FL
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Zip | 33403
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Country | US
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Telephone | 561-635-4887
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Fax | 561-688-8143
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW9808
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License Number State | FL
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