Basic Information
| Provider Information | |||||||||
| NPI: | 1336664135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LONG | ||||||||
| FirstName: | HALEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1284 | ||||||||
| Address2: | |||||||||
| City: | MITCHELL | ||||||||
| State: | SD | ||||||||
| PostalCode: | 573017284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6059956370 | ||||||||
| FaxNumber: | 6059956374 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 EAST HAVENS | ||||||||
| Address2: | |||||||||
| City: | MITCHELL | ||||||||
| State: | SD | ||||||||
| PostalCode: | 57301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6059956370 | ||||||||
| FaxNumber: | 6059956374 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2017 | ||||||||
| LastUpdateDate: | 08/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 724-SLP | SD | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.