Provider Demographics
NPI:1194062182
Name:LANG, JENNIFER (MSW, LSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2409
Mailing Address - Country:US
Mailing Address - Phone:614-340-6777
Mailing Address - Fax:614-572-0859
Practice Address - Street 1:1033 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2409
Practice Address - Country:US
Practice Address - Phone:614-340-6777
Practice Address - Fax:614-572-0859
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS11003741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068920Medicaid