Provider Demographics
NPI:1497308308
Name:LONG, KAYDEE MAE
Entity Type:Individual
Prefix:MRS
First Name:KAYDEE
Middle Name:MAE
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KAYDEE
Other - Middle Name:MAE
Other - Last Name:TARIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3265 BIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4122
Mailing Address - Country:US
Mailing Address - Phone:541-816-4747
Mailing Address - Fax:541-787-4011
Practice Address - Street 1:3265 BIDDLE RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4122
Practice Address - Country:US
Practice Address - Phone:541-816-4747
Practice Address - Fax:541-787-4011
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR016537235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist