Provider Demographics
NPI:1205207651
Name:LONG, CYNTHIA A
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46810 777TH RD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:NE
Mailing Address - Zip Code:68844-5104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:76 PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-4841
Practice Address - Country:US
Practice Address - Phone:308-237-5927
Practice Address - Fax:308-237-5920
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist