Provider Demographics
NPI:1073928248
Name:OLDFIELD, MORGAN CLARISSA
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:CLARISSA
Last Name:OLDFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96157 STONEY GLEN CT
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-6571
Mailing Address - Country:US
Mailing Address - Phone:334-596-2679
Mailing Address - Fax:
Practice Address - Street 1:46 OSPREY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:AMELIA ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32034-4955
Practice Address - Country:US
Practice Address - Phone:334-596-2679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 14637235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist