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General NPI Number Information
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NPI Number | 1194167379
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Entity Type | Individual
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Provider Name | JENNI KAY LONG LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/29/2013
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 2863 N OLD MISSOURI RD
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3765
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Country | US
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Telephone | 479-348-2397
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Fax |
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Provider Business Mailing Address
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Address Line | 2454 N KARYN AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-3422
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Country | US
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Telephone | 610-710-9221
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW130671
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 09924553
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License Number State | CO
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