Provider Demographics
NPI:1154679330
Name:MAUDIE, MORGAN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:
Last Name:MAUDIE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:HOMER CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15748-1231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:143 HARTMAN RD
Practice Address - Street 2:SUITE 12
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-7220
Practice Address - Country:US
Practice Address - Phone:800-945-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010985235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102644510Medicaid