LISA JAYNE LONG

LOGAN, WV
NPI1205013695
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy235Z00000X Speech-Language Pathologist,
(Licence: WV  12089807)
Enumeration Date2008-01-28
Last Update Date2008-01-28
Business Address
Mrs. LISA JAYNE LONG MA CCC-S
506 HOLLY AVE
LOGAN, WV 25601-3306
Phone number: 304-792-2073
Mailing Address
Mrs. LISA JAYNE LONG MA CCC-S
158 NIGHBERT AVE
LOGAN, WV 25601-4003
Phone number: 304-752-8962
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