Healthcare Provider Details

I. General information

NPI: 1134035223
Provider Name (Legal Business Name): MAGGIE RUTH LONGBERRY ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 TIMBER LN
DAYTON OH
45414-4528
US

IV. Provider business mailing address

2011 TIMBER LN
DAYTON OH
45414-4528
US

V. Phone/Fax

Practice location:
  • Phone: 937-275-7469
  • Fax: 937-274-5778
Mailing address:
  • Phone: 937-275-7469
  • Fax: 937-274-5778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.00415
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: