MEDICARE: MS. ROSEMARY NMN LANGE LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	180.007239	IL

General Provider Information

NPI Number	:	1255620076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSEMARY NMN LANGE LCPC

Provider Business Mailing Address
First Line	:	50 NORTHGATE BLVD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-5858
Country	:	US
Telephone Number	:	618-877-4420
Fax Number	:	618-877-9250

Provider Business Practice Location Address
First Line	:	50 NORTHGATE BLVD
Second Line	:
City	:	GRANITE CITY
State	:	IL
Zip	:	62040-5858
Country	:	US
Telephone Number	:	618-877-4420
Fax Number	:	618-877-9250

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2011
Last Update Date	:	04/01/2011

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