Provider Demographics
NPI:1033309703
Name:LONG, JONI MICHELLE (SLP)
Entity type:Individual
Prefix:
First Name:JONI
Middle Name:MICHELLE
Last Name:LONG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:MICHELLE
Other - Last Name:LONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:1807 N COMANCHE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-2701
Mailing Address - Country:US
Mailing Address - Phone:480-584-5585
Mailing Address - Fax:
Practice Address - Street 1:1807 N COMANCHE DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2701
Practice Address - Country:US
Practice Address - Phone:480-584-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP5465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist