Provider Demographics
NPI:1992094551
Name:LANG, JENNIFER JUNE (MS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JUNE
Last Name:LANG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 PEORIA ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:IL
Mailing Address - Zip Code:62656-1653
Mailing Address - Country:US
Mailing Address - Phone:309-678-2666
Mailing Address - Fax:
Practice Address - Street 1:625 E. MONROE ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:IL
Practice Address - Zip Code:61427
Practice Address - Country:US
Practice Address - Phone:309-785-5012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.006405235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist