Individual
MRS. SUSAN P LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
22633 IMPERIAL RD, MARYVILLE, MO 64468-7385
(660) 562-2473
Mailing address
22633 IMPERIAL RD, MARYVILLE, MO 64468-7385
(660) 562-2473
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
107240
MO
Other
Enumeration date
06/14/2007
Last updated
07/08/2007
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