Individual
LESSIE ELLEN LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPS
Contact information
Practice address
925 HIGHWAY V V, KENNETT, MO 63857-3866
(573) 359-2600
Mailing address
925 HIGHWAY V V, KENNETT, MO 63857-3866
(573) 359-2600
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/19/2018
Last updated
09/19/2018
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