Provider Demographics
NPI:1902985922
Name:LANG, LISA (MS, ATRL-BC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:LANG
Suffix:
Gender:F
Credentials:MS, ATRL-BC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:LANG LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2027 N 71ST ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1823
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14135 NORTH CEDARBURG ROAD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097
Practice Address - Country:US
Practice Address - Phone:414-702-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51-036101YM0800X, 221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952808701OtherNPI #2/ORGANIZATION NPI #
1902985922OtherINDIVIDUAL NPI #
01-226OtherATCB BOARD CERTIFICATION #
WI51-036OtherPSYCHOTHERAPY LICENSE #
WI40961100Medicaid