Provider Demographics
NPI:1699804856
Name:LANGE, NICOLE CHRISTINE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:CHRISTINE
Last Name:LANGE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 W FARRAGUT AVE
Mailing Address - Street 2:UNIT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1269
Mailing Address - Country:US
Mailing Address - Phone:773-494-9561
Mailing Address - Fax:773-907-0504
Practice Address - Street 1:2032 W FARRAGUT AVE
Practice Address - Street 2:UNIT 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1269
Practice Address - Country:US
Practice Address - Phone:773-494-9561
Practice Address - Fax:773-907-0504
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist