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NPI Code Detail

MEDICARE: KIETRAYONNA LONG

MEDICARE: KIETRAYONNA LONG
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1689537300
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIETRAYONNA LONG
Provider Business Mailing Address
First Line : 741 SCHOLL RD
Second Line :
City : MANSFIELD
State : OH
Zip : 44907-1587
Country : US
Telephone Number : 419-756-1717
Fax Number :
Provider Business Practice Location Address
First Line : 741 SCHOLL RD
Second Line :
City : MANSFIELD
State : OH
Zip : 44907-1587
Country : US
Telephone Number : 419-756-1717
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2025
Last Update Date : 12/09/2025

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Directions to “ KIETRAYONNA LONG ” Practice Location

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