Individual
SUSAN M LONG
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
9000 W WISCONSIN AVE, MILWAUKEE, WI 53226-3518
(414) 266-2997
(414) 266-6189
Mailing address
W256N9267 TOMAHAWK DR, SUSSEX, WI 53089-1049
(414) 266-2997
(414) 266-6189
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
436156
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41148900
—
WI
01
—
436156
AUDIOLOGY STATE LICENSE
WI
Enumeration date
06/14/2006
Last updated
07/08/2007
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