Jeannie Long

NPI #1164904710 in Waynoka, Oklahoma

Provider Information

NPI Number: 1164904710
Entity Type: Individual
Name: Jeannie Long
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Peer Specialist
Enumeration Date: Aug 30, 2018
Last Updated: Aug 30, 2018

Practice Location

Address: 1095 NICKERSON ST
City: Waynoka
State: Oklahoma
ZIP Code: 73860-1252
Phone: (580) 824-0674

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Peer Specialist	175T00000X	Primary

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