Healthcare Provider Details

I. General information

NPI: 1902349301
Provider Name (Legal Business Name): KATHERINE SPALDING LONG MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE SPALDING MS

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CADYS FALLS RD
MORRISTOWN VT
05661-9137
US

IV. Provider business mailing address

51 VISTA DR
WATERBURY CENTER VT
05677-8023
US

V. Phone/Fax

Practice location:
  • Phone: 802-888-5229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number144.0134093
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: