Provider Demographics
NPI:1871475764
Name:LONG, JODY L
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:LONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-1199
Mailing Address - Country:US
Mailing Address - Phone:937-496-2000
Mailing Address - Fax:
Practice Address - Street 1:1771 OLD PALMER RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-9084
Practice Address - Country:US
Practice Address - Phone:937-496-2000
Practice Address - Fax:937-463-2958
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2504362-TRNE104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker