Provider Demographics
NPI:1033520663
Name:LONG, ALAINA LINDSEY RYAN (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:ALAINA
Middle Name:LINDSEY RYAN
Last Name:LONG
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 CANVASBACK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-9161
Mailing Address - Country:US
Mailing Address - Phone:802-431-7100
Mailing Address - Fax:
Practice Address - Street 1:359 CANVASBACK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-9161
Practice Address - Country:US
Practice Address - Phone:802-431-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL011606235Z00000X
DE01-0001441235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty