Individual
JAYDE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
107 SUMMER LN, WEST MONROE, LA 71291-3501
(318) 396-1969
(318) 396-1970
Mailing address
107 SUMMER LN, WEST MONROE, LA 71291-3501
(318) 396-1969
(318) 396-1970
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7730
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7730
LICENSE
LA
Enumeration date
09/13/2016
Last updated
09/13/2016
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