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Individual

JENNI KAY LONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
2863 N OLD MISSOURI RD, FAYETTEVILLE, AR 72703-3765
(479) 348-2397
Mailing address
2454 N KARYN AVE, FAYETTEVILLE, AR 72703-3422
(610) 710-9221

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
SW130671
PA
1041C0700X
Clinical Social Worker
Primary
09924553
CO

Other

Enumeration date
07/29/2013
Last updated
09/07/2022
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