1922363068 NPI number — JENNIFFER A LONGO LCSW

Table of content: JENNIFFER A LONGO LCSW (NPI 1922363068)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922363068 NPI number — JENNIFFER A LONGO LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONGO
Provider First Name:
JENNIFFER
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LONGO
Provider Other First Name:
JENNIFFER
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922363068
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
410 WINDWARD WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59901-2680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-751-8331
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 WINDWARD WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALISPELL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-751-8331
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  37207 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A3419 . This is a "STATE OF OREGON STATE BOARD OF LICENSED SOCIAL WORKERS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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