Provider Demographics
NPI:1134464662
Name:MORTON, ROSALYN M
Entity Type:Individual
Prefix:MS
First Name:ROSALYN
Middle Name:M
Last Name:MORTON
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 1:23 HAWTHORNE CT
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5011
Mailing Address - Country:US
Mailing Address - Phone:708-201-8052
Mailing Address - Fax:
Practice Address - Street 1:2145 W 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1018
Practice Address - Country:US
Practice Address - Phone:773-233-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency