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General NPI Number Information
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NPI Number | 1225848260
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Entity Type | Individual
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Provider Name | KELLY MARGARET LANG LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/11/2025
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Last Update Date | 01/11/2025
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Provider Practice Location Address
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Address Line | 10150 W NATIONAL AVE STE 370
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City | WEST ALLIS
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State | WI
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Zip | 53227-2152
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Country | US
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Telephone | 414-501-7555
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Fax |
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Provider Business Mailing Address
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Address Line | 18155 IRIS CT APT 102
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City | BROOKFIELD
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State | WI
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Zip | 53045-5656
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Country | US
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Telephone | 262-719-9271
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 11731-123
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License Number State | WI
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