MEDICARE: MISS BRITANIE NICOLE LONG SLP-CCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	103788	TX

General Provider Information

NPI Number	:	1184859563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BRITANIE NICOLE LONG SLP-CCC

Provider Business Mailing Address
First Line	:	4840 W PANTHER CREEK DR STE 206
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-3542
Country	:	US
Telephone Number	:	281-681-3020
Fax Number	:	281-298-9905

Provider Business Practice Location Address
First Line	:	4840 W PANTHER CREEK DR STE 206
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-3542
Country	:	US
Telephone Number	:	281-681-3020
Fax Number	:	281-298-9905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2009
Last Update Date	:	05/28/2009

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Directions to “ MISS BRITANIE NICOLE LONG SLP-CCC” Practice Location

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