Healthcare Provider Details

I. General information

NPI: 1093620593
Provider Name (Legal Business Name): AUDREY LYNN LONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 N COMMERCIAL ST STE 1355
BELLINGHAM WA
98225-4452
US

IV. Provider business mailing address

1124 NEVADA ST
BELLINGHAM WA
98229-5721
US

V. Phone/Fax

Practice location:
  • Phone: 360-393-5114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: