Provider Demographics
NPI:1386915395
Name:LONG, MEGAN E (MA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:LONG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 CREEK VIEW DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:AR
Mailing Address - Zip Code:72007-9739
Mailing Address - Country:US
Mailing Address - Phone:660-216-4024
Mailing Address - Fax:
Practice Address - Street 1:255 CREEK VIEW DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:AR
Practice Address - Zip Code:72007-9739
Practice Address - Country:US
Practice Address - Phone:660-216-4024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#P8498235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARSP#P8498OtherSPEECH LANGUAGE PATHOLOGTST