Jessica Long, LAC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

AC196024 Issued in OR

Practice address

1815 SW Marlow Ave Ste 110
Portland, OR 97225-5186

Phone

(503) 292-0765

Fax

(503) 292-5208

NPI assigned

Oct 27, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1666828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697673600000",
    "number": "1891402038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 SW MARLOW AVE STE 110",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255186",
            "telephone_number": "503-292-0765",
            "fax_number": "503-292-5208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1815 SW MARLOW AVE STE 110",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255186",
            "telephone_number": "503-292-0765",
            "fax_number": "503-292-5208"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1716 NE 42nd Ave",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972131527",
            "country_code": "US",
            "telephone_number": "207-939-4705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LONG",
        "first_name": "JESSICA",
        "credential": "LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-27",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "WA",
            "license": "AC61332636",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC196024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.progrehab.com",
            "affiliation": "N",
            "endpointDescription": "Website address",
            "address_1": "1815 SW Marlow Ave Ste 110",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972255186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Derrick Long
• Elizabeth Long, LCSW
• Evan Gregory Long, D.O.
• Georgia Long
• Heidi H Long, DOULA
• Jessica Kay Long
• John Hunter Long, RN
• Justin Long, LAC
• Kaitlyn Shea Long
• Katie Jo Long, RRT

• Acupuncturist in Portland, OR
• Providers in Portland, OR by specialty
• Acupuncturist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2023; 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.