Kelly Anne Long
Social Worker, Clinical in Bloomington, IL. Individual provider (NPI-1).
NPI number1154423937
StatusActive
Last updated in NPPESMar 18, 2025
Details
- NPI
- 1154423937
- Entity type
- Individual (NPI-1)
- Name
- Kelly Anne Long
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Sep 2, 2006
- Certification date
- Mar 18, 2025
- Last updated
- Mar 18, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1041C0700X | Social Worker, Clinical | 149027456 | IL | Yes |
Practice location
108 W Market StBloomington, IL 61701-3918
Phone 309-827-5351 · Fax 309-829-6808
Mailing address
913 Chippewa StNormal, IL 61761-5758
Phone 309-530-5884
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