Individual
JENNIFER LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
220 WASHINGTON AVE, OSHKOSH, WI 54901-5030
(920) 236-4700
(920) 236-1157
Mailing address
220 WASHINGTON AVE, OSHKOSH, WI 54901-5030
(920) 236-4700
(920) 236-1157
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
8465-123
WI
104100000X
Social Worker
129016121
WI
1041C0700X
Clinical Social Worker
8465-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000084287
MEDICARE
WI
05
—
42139300
—
WI
05
—
42156000
—
WI
Enumeration date
05/23/2013
Last updated
11/17/2016
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