Healthcare Provider Details

I. General information

NPI: 1972431450
Provider Name (Legal Business Name): KATHERINE LONG PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 SISK RD STE 5A
MODESTO CA
95356-0540
US

IV. Provider business mailing address

1470 TRAMWAY PL
TURLOCK CA
95380-3084
US

V. Phone/Fax

Practice location:
  • Phone: 209-485-8299
  • Fax:
Mailing address:
  • Phone: 209-485-8299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: