Individual
JENNIFER DAWN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
620 N STATE ST, STANTON, MI 48888-8749
(616) 821-5266
Mailing address
5809 E KLEES RD, STANTON, MI 48888-9408
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501008361
MI
Other
Enumeration date
07/31/2019
Last updated
07/31/2019
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