Provider Demographics
NPI:1902349301
Name:LONG, KATHERINE SPALDING (MS)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SPALDING
Last Name:LONG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:SPALDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:51 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:WATERBURY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05677-8023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:480 CADYS FALLS RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:VT
Practice Address - Zip Code:05661-9137
Practice Address - Country:US
Practice Address - Phone:802-888-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
VT144.0134093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist