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NPI Code Detail

MEDICARE: DONNA LONG M.S., CCC-SLP

MEDICARE: DONNA LONG M.S., CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language PathologistSA5860FL

General Provider Information

NPI Number : 1568617314
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA LONG M.S., CCC-SLP
Provider Business Mailing Address
First Line : 4202 OKEECHOBEE RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34947-5414
Country : US
Telephone Number : 772-462-6636
Fax Number : 772-462-6635
Provider Business Practice Location Address
First Line : 4202 OKEECHOBEE RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34947-5414
Country : US
Telephone Number : 772-462-6636
Fax Number : 772-462-6635
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2008
Last Update Date : 11/20/2008

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Directions to “ DONNA LONG M.S., CCC-SLP” Practice Location

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