Provider Demographics
NPI:1720233620
Name:LONG, LAUREN GRACE (MA CCC-SLP TSSLD)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:GRACE
Last Name:LONG
Suffix:
Gender:F
Credentials:MA CCC-SLP TSSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 WEST DR
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-4145
Mailing Address - Country:US
Mailing Address - Phone:914-844-3629
Mailing Address - Fax:
Practice Address - Street 1:43 WEST DR
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-4145
Practice Address - Country:US
Practice Address - Phone:914-844-3629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018268-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist