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General NPI Number Information
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NPI Number | 1831642719
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Entity Type | Individual
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Provider Name | ALYSE LANGE LMSW, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 4341 S WESTNEDGE AVE STE 1203
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City | KALAMAZOO
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State | MI
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Zip | 49008-3284
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Country | US
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Telephone | 269-823-2675
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Fax |
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Provider Business Mailing Address
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Address Line | 125 GILKISON AVE
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City | KALAMAZOO
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State | MI
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Zip | 49006-8320
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Country | US
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Telephone | 269-615-0013
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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 | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | L-99168
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6801114754
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License Number State | MI
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