Provider Demographics
NPI:1578183232
Name:LONG, REBEKAH LYNN (BA)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:LYNN
Last Name:LONG
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 30TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-4104
Mailing Address - Country:US
Mailing Address - Phone:319-862-1050
Mailing Address - Fax:319-862-1052
Practice Address - Street 1:4050 BOWLING ST SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-5005
Practice Address - Country:US
Practice Address - Phone:319-862-1050
Practice Address - Fax:319-862-1052
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)