Provider Demographics
NPI:1679284806
Name:LONG, CARA JOANNE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:JOANNE
Last Name:LONG
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 CHRISTIE AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2304
Mailing Address - Country:US
Mailing Address - Phone:419-660-1758
Mailing Address - Fax:
Practice Address - Street 1:64 CHRISTIE AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2304
Practice Address - Country:US
Practice Address - Phone:419-660-1758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH.9925235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist