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General NPI Number Information
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NPI Number | 1255032736
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Entity Type | Individual
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Provider Name | COURTNEY LONG
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Gender | Female
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Dates
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Enumeration Date | 03/13/2023
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 221 GROVE ST
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City | HOPEDALE
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State | IL
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Zip | 61747-7546
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Country | US
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Telephone | 309-201-2020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 553
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City | HOPEDALE
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State | IL
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Zip | 61747-0553
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Country | US
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Telephone | 309-201-0620
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State | IL
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