Healthcare Provider Details

I. General information

NPI: 1871475764
Provider Name (Legal Business Name): JODY L LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 OLD PALMER RD NW
WASHINGTON COURT HOUSE OH
43160-9084
US

IV. Provider business mailing address

600 WAYNE AVE
DAYTON OH
45410-1199
US

V. Phone/Fax

Practice location:
  • Phone: 937-496-2000
  • Fax: 937-463-2958
Mailing address:
  • Phone: 937-496-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2504362-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: