Provider Demographics
NPI:1427468321
Name:LANG, KAITLYN A (EDS, NCSP)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:A
Last Name:LANG
Suffix:
Gender:F
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S KEOWEE ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2242
Mailing Address - Country:US
Mailing Address - Phone:937-225-4598
Mailing Address - Fax:937-496-7781
Practice Address - Street 1:200 S KEOWEE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2242
Practice Address - Country:US
Practice Address - Phone:937-225-4598
Practice Address - Fax:937-496-7781
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist