Provider Demographics
NPI:1194409821
Name:LONG, KATHLEEN THERESE (AUD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:THERESE
Last Name:LONG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1603 MEDICAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7904
Mailing Address - Country:US
Mailing Address - Phone:512-260-2665
Mailing Address - Fax:512-260-2668
Practice Address - Street 1:4859 WILLIAMS DR STE 109
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-2304
Practice Address - Country:US
Practice Address - Phone:512-357-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81504231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter