Provider Demographics
NPI:1750573762
Name:LONGMEIER, JACQUELYN S (SLP)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:S
Last Name:LONGMEIER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 41ST ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-3321
Mailing Address - Country:US
Mailing Address - Phone:601-693-0948
Mailing Address - Fax:601-693-2494
Practice Address - Street 1:2208 41ST ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-3321
Practice Address - Country:US
Practice Address - Phone:601-693-0948
Practice Address - Fax:601-693-2494
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS0028235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1285752725Medicaid