Provider Demographics
NPI:1386310357
Name:LANGE, JENNY (MSW)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:LANGE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 BOUL AVE
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-4294
Mailing Address - Country:US
Mailing Address - Phone:618-233-1054
Mailing Address - Fax:
Practice Address - Street 1:1721 BOUL AVE
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-4294
Practice Address - Country:US
Practice Address - Phone:618-233-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool