=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982837241
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH ANN LANG M.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/02/2009
-----------------------------------------------------
Last Update Date | 09/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 747 52ND ST
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94609-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-428-3792
-----------------------------------------------------
Fax | 510-655-1004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 747 52ND ST
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94609-1809
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-428-3792
-----------------------------------------------------
Fax | 510-655-1004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SP17286
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------