Provider Demographics
NPI:1760133839
Name:LONG, MAGGIE JEANNE (CF- SLP)
Entity Type:Individual
Prefix:MS
First Name:MAGGIE
Middle Name:JEANNE
Last Name:LONG
Suffix:
Gender:F
Credentials:CF- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 HILL AVE
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3315
Mailing Address - Country:US
Mailing Address - Phone:831-239-2514
Mailing Address - Fax:
Practice Address - Street 1:820 BAY AVE STE 212
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2103
Practice Address - Country:US
Practice Address - Phone:831-854-2060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15666235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist