Provider Demographics
NPI:1881003903
Name:LONG, REBECCA JEAN (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JEAN
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 1:110 JOHNSON LN
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-1321
Mailing Address - Country:US
Mailing Address - Phone:606-546-5109
Mailing Address - Fax:
Practice Address - Street 1:110 JOHNSON LN
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-1321
Practice Address - Country:US
Practice Address - Phone:606-546-5109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1990235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist