Long, Lisa Jayne

Long, Lisa Jayne is an sole proprietor health care provider with primary practice located at 506 Holly Ave , Logan WV 25601-3306. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Long, Lisa Jayne can be contacted via phone (304) 792-2073.

Contact Information

Primary practice address
506 Holly Ave Logan WV 25601-3306
Phone: (304) 792-2073
Fax: (304) 752-7471
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X 12089807 West Virginia

Profile Details

NPI number 1205013695
LBN Legal business name Long, Lisa Jayne
Credentials MA CCC-S
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 28th, 2008
Last updated Jan 28th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205013695 NPPES
West Virginia MEDICAID 7402318000

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