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Individual

SHANNA LONG

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMSW

Contact information

Practice address
5815 BROADWAY AVE, GREAT BEND, KS 67530-3123
(620) 792-2544
Mailing address
5815 BROADWAY AVE, GREAT BEND, KS 67530-3123
(620) 792-2544

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
10242
KS

Other

Enumeration date
10/28/2016
Last updated
10/28/2016
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