Individual provider Active NPI

Stephanie Roberts Long, AUD DOCTOR AUDILOGY

  • Audiologist
  • Appleton, WI
National Provider Identifier
1336314814
Registry record updated May 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
232-156 Issued in WI
Practice address
W3124 Van Roy Rd
Appleton, WI 54915-3982
Phone
(920) 915-9077
NPI assigned
Apr 25, 2008
Last updated
May 11, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2010

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 232-156 WI Primary
Assistive Technology Practitioner Audiologist 231HA2400X 232-156 WI
Audiologist-Hearing Aid Fitter 237600000X 232-156 WI

Addresses

Primary practice location

W3124 Van Roy Rd
Appleton, WI 54915-3982

Mailing address

W3124 Van Roy Rd
Appleton, WI 54915-3982
Phone (920) 915-9077

Other identifiers 1

IdentifierTypeStateIssuer
41128700MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
232-156WIMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Fox Valley Hearing Center CurrentSince Dec 17, 2018 Accepting new patients

Locations

W3124 Van Roy Rd
Appleton, WI 54915
Phone (920) 730-2747

1820 West Pointe Dr
Oshkosh, WI 54902
Phone (920) 233-1800

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273536000000",
    "number": "1336314814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W3124 VAN ROY RD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549153982",
            "telephone_number": "920-915-9077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W3124 VAN ROY RD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549153982",
            "telephone_number": "920-915-9077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LONG",
        "first_name": "STEPHANIE",
        "middle_name": "ROBERTS",
        "name_prefix": "Dr.",
        "credential": "AUD DOCTOR  AUDILOGY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-25",
        "last_updated": "2010-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "WI",
            "license": "232-156",
            "primary": true
        },
        {
            "code": "231HA2400X",
            "taxonomy_group": "",
            "desc": "Audiologist, Assistive Technology Practitioner",
            "state": "WI",
            "license": "232-156",
            "primary": false
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "WI",
            "license": "232-156",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41128700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2010; 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.