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General NPI Number Information
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NPI Number | 1447445705
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Entity Type | Individual
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Provider Name | KARLA PRESTRIDGE LONG M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 5165 CANAL ST
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City | MILTON
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State | FL
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Zip | 32570-2256
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Country | US
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Telephone | 850-623-4054
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Fax |
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Provider Business Mailing Address
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Address Line | 1602 GOVERNORS DR #2216
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City | PENSACOLA
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State | FL
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Zip | 32514-9442
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Country | US
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Telephone |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA9040
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License Number State | FL
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