Lisa Jayne Long, MA CCC-S

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

12089807 Issued in WV

Practice address

506 Holly Ave
Logan, WV 25601-3306

Phone

(304) 792-2073

Fax

(304) 752-7471

NPI assigned

Jan 28, 2008

Last updated

Jan 28, 2008By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201478400000",
    "number": "1205013695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 NIGHBERT AVE",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256014003",
            "telephone_number": "304-752-8962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 HOLLY AVE",
            "city": "LOGAN",
            "state": "WV",
            "postal_code": "256013306",
            "telephone_number": "304-792-2073",
            "fax_number": "304-752-7471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "LISA",
        "middle_name": "JAYNE",
        "name_prefix": "Mrs.",
        "credential": "MA CCC-S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-01-28",
        "last_updated": "2008-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WV",
            "license": "12089807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7402318000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Logan-Mingo Area Mental Health, Inc
• Logan-Mingo Area Mental Health, Inc (Mountain Laurel Integrated Healthcare)
• Logan-Mingo Area Mental Health, Inc.
• Logan-Mingo Area Mental Health, Inc.
• James Robert Long II, D.O.
• Lucas Eye Care PLLC
• Larry Lucas, D.O.
• Lonnie Kent Lucas Sr., O.D.
• Erica Lupson, APRN
• Candace Leigh Lusk, COTA

• Speech-Language Pathologist in Logan, WV
• Providers in Logan, WV by specialty
• Speech-Language Pathologist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.