Provider Demographics
NPI:1538713656
Name:MILLER-LANGE, JESSICA NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:NICOLE
Last Name:MILLER-LANGE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MONROE ST N
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:IA
Mailing Address - Zip Code:50641-9709
Mailing Address - Country:US
Mailing Address - Phone:319-283-8080
Mailing Address - Fax:
Practice Address - Street 1:223 S WALNUT AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6974
Practice Address - Country:US
Practice Address - Phone:515-233-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor