Provider Demographics
NPI:1083335475
Name:WILEY, MORGAN THERESA
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:THERESA
Last Name:WILEY
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 1:53 NASSAU RD
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5615
Mailing Address - Country:US
Mailing Address - Phone:845-392-8917
Mailing Address - Fax:
Practice Address - Street 1:250 TUYTENBRIDGE RD
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5429
Practice Address - Country:US
Practice Address - Phone:845-336-7235
Practice Address - Fax:845-336-7248
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3066840OtherPROLIABILITY