Provider Demographics
NPI:1073768453
Name:MORGAN, COLLEEN SUSAN (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:SUSAN
Last Name:MORGAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 TRAVERS AVE
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1433
Mailing Address - Country:US
Mailing Address - Phone:914-777-3495
Mailing Address - Fax:
Practice Address - Street 1:315 TRAVERS AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-1433
Practice Address - Country:US
Practice Address - Phone:914-777-3495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012624-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist