Provider Demographics
NPI:1093576209
Name:MORGAN, TYLER NICOLE (CF-SLP)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:NICOLE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 OLD JAMES RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-3551
Mailing Address - Country:US
Mailing Address - Phone:478-388-4194
Mailing Address - Fax:
Practice Address - Street 1:1385 OGLETHORPE ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1511
Practice Address - Country:US
Practice Address - Phone:478-746-1037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012890235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist