Individual
MRS. HARRIETT GAYLE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
2713 SE I ST STE 5, BENTONVILLE, AR 72712-0078
(479) 250-4355
Mailing address
3611 AMBROSIA LN, BENTONVILLE, AR 72712-3054
(417) 669-6598
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2023027329
MO
Other
Enumeration date
08/10/2023
Last updated
11/06/2024
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