Provider Demographics
NPI:1386722247
Name:LANGE, DONALD EDWARD (PHD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EDWARD
Last Name:LANGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 SW BROADLEAF DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6370
Mailing Address - Country:US
Mailing Address - Phone:503-245-9748
Mailing Address - Fax:503-293-2310
Practice Address - Street 1:8040 SW CAPITOL HILL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2670
Practice Address - Country:US
Practice Address - Phone:503-977-9949
Practice Address - Fax:503-293-2310
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR644103G00000X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service