Provider Demographics
NPI:1053299347
Name:LONG, CHLOE ELIZABETH (BS)
Entity type:Individual
Prefix:
First Name:CHLOE
Middle Name:ELIZABETH
Last Name:LONG
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1298 STONECREEK RD SW
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-7541
Mailing Address - Country:US
Mailing Address - Phone:330-447-4031
Mailing Address - Fax:
Practice Address - Street 1:1298 STONECREEK RD SW
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-7541
Practice Address - Country:US
Practice Address - Phone:330-447-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH060004113390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program