Doctor Name: | MRS. MYRA A LONG |
NPI Number: | 1356552822 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SLP |
License Number: | 1710 |
Business Practice Address: | 140 Thompson Ln Forrest City, AR - 723357648 |
Business Phone Number: | 8702706948 |
Business Fax Number: | 8706332934 |
Mailing Address: | 140 Thompson Ln, FORREST CITY |
State: | AR |
Postal Code: | 723357648 |
Phone Number: | 8702706948 |
Fax Number: | 8706332934 |
NPI Enumeration Date: | 05/25/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 1710 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AR |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |