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NPI Code Detail

MEDICARE: JAY LONG

MEDICARE: JAY LONG
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1952230674
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAY LONG
Provider Business Mailing Address
First Line : 7615 GOLDEN TRIANGLE DR STE A
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-3733
Country : US
Telephone Number : 952-767-5900
Fax Number :
Provider Business Practice Location Address
First Line : 7615 GOLDEN TRIANGLE DR STE A
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-3733
Country : US
Telephone Number : 952-767-5900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2026
Last Update Date : 05/18/2026

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Directions to “ JAY LONG ” Practice Location

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