Kelly L. Lange Psychology, a Professional Corporation

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

21401 Issued in CA

Legal business name

KELLY L. LANGE PSYCHOLOGY, A PROFESSIONAL CORPORATION

Practice address

9606 Tierra Grande St
Suite 107
San Diego, CA 92126-6501

Phone

(858) 693-3113

NPI assigned

Jul 7, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kelly L. Lange, PH.D.

Title

Clinical Neuropsychologist

Phone

(858) 218-4601

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235337528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9606 TIERRA GRANDE ST",
            "address_2": "SUITE 107",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921266501",
            "telephone_number": "858-693-3113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9606 TIERRA GRANDE ST",
            "address_2": "SUITE 107",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921266501",
            "telephone_number": "858-693-3113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY L. LANGE PSYCHOLOGY, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LANGE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "CLINICAL NEUROPSYCHOLOGIST",
        "authorized_official_telephone_number": "858-218-4601",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "21401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marlyn Kellogg
• Shannon Marie Kellogg, MA
• Sopahn Kellogg
• Kelly J Hwang DDS Inc
• Kelly Keane OD Professional Corporation
• Kelly S Keefe MD Inc
• Kyelunye Kelly-Adegbola
• Martha Kelly-Luken
• Adrienne M. Kelly, MD
• Amanda Marie Kelly

• Clinical Neuropsychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Neuropsychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.