Healthcare Provider Details

I. General information

NPI: 1902077431
Provider Name (Legal Business Name): LAURIE LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 CHESTNUT ST STE 203
BIRMINGHAM MI
48009-6464
US

IV. Provider business mailing address

751 CHESTNUT ST STE 203
BIRMINGHAM MI
48009-6464
US

V. Phone/Fax

Practice location:
  • Phone: 248-430-8425
  • Fax:
Mailing address:
  • Phone: 248-430-8425
  • Fax: 248-282-7407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1601000160
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: