Provider Demographics
NPI:1457442386
Name:LONG, AMANDA J (AUD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:LONG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CARLISLE ST STE A
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-5100
Mailing Address - Country:US
Mailing Address - Phone:717-632-5558
Mailing Address - Fax:717-632-7493
Practice Address - Street 1:600 CARLISLE ST STE A
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-5100
Practice Address - Country:US
Practice Address - Phone:717-632-5558
Practice Address - Fax:717-632-7493
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT001154L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist