Provider Demographics
NPI:1780745646
Name:PRINCE-LONG, GEORGIANNA LEE (AUD)
Entity type:Individual
Prefix:MRS
First Name:GEORGIANNA
Middle Name:LEE
Last Name:PRINCE-LONG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17420 CANNONS MILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43968
Mailing Address - Country:US
Mailing Address - Phone:412-913-5475
Mailing Address - Fax:
Practice Address - Street 1:15700 STATE ROUTE 170 STE A
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9657
Practice Address - Country:US
Practice Address - Phone:330-368-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005954231H00000X
OHA01439231H00000X
OHA.01439231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist