Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1205013695 Individual Practitioner Female Practitioner

Lisa Jayne Long , MA CCC-S

Speech-Language Pathologist • Logan, WV

Professional Overview & Biography Verified Profile Summary

Lisa Long, MA CCC-S is a registered healthcare professional specializing in Speech-Language Pathologist in Logan, WV. Practice services are available at 506 HOLLY AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

506 Holly Ave

Logan, WV 256013306

Telephone 3047922073
Fax 3047527471

Specialty Benchmarks & Practice Insights

Comparative analytics for Speech-Language Pathologist in Logan, WV

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 15.5 Yrs
Regional Practice Density
11 Specialists

Practicing in Logan, WV (1413 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Speech-Language Pathologist Primary Specialty

NUCC Taxonomy Code: 235Z00000X

State License WV 12089807

The speech-language pathologist is the professional who engages in clinical services, prevention, advocacy, education, administration, and research in the areas of communication and swallowing across the life span from infancy through geriatrics. Speech-language pathologists address typical and atypical impairments and disorders related to communication and swallowing in the areas of speech sound production, resonance, voice, fluency, language (comprehension and expression), cognition, and feeding and swallowing.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
7402318000 (WV)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

6 Associated Practitioners
NPI 1104003599

MAEDS

Deangela Conley , MA CCC-SLP

Speech-Language Pathologist

NPI 1174700546

MACCCSLP

Donald Pinckney , OT, L

Occupational Therapist

NPI 1326225772

Occupational Therapist, L

Sabrina Grace , MS CCC-S

Speech-Language Pathologist

NPI 1346427721

MSCCCS

Tiffany Mayo , MS

Speech-Language Pathologist

NPI 1659558047

Master of Science

Lothell Pack , MA, EDS

Psychologist - School

NPI 1750469185

Master of Arts, EDS

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active January 28, 2008

NPI status registered as active in NPPES database

📍
Updated Practice Location January 28, 2008

Registered at 506 HOLLY AVE, LOGAN, WV 256013306 (Tel: 3047922073)

📍
Updated Business Mailing Address January 28, 2008

Registered at 158 NIGHBERT AVE, LOGAN, WV 256014003 (Tel: 3047528962)

👤
Provider Name / Credentials Updated January 28, 2008

Recorded as LISA LONG, MA CCC-S

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) January 28, 2008

Speech-Language Pathologist (License #12089807 in WV)

🟢
Initial NPI Registration & Enumeration January 28, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1205013695
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: January 28, 2008
Last Update: January 28, 2008
Sole Proprietor: Yes

Mailing Address

158 Nighbert Ave

Logan, WV 256014003

Phone: 3047528962

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.