Provider Demographics
NPI:1164747150
Name:MORRIS, MISCHA ADAIR (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MISCHA
Middle Name:ADAIR
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 HELEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-4704
Mailing Address - Country:US
Mailing Address - Phone:434-944-4833
Mailing Address - Fax:
Practice Address - Street 1:1994 TIGER DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-6855
Practice Address - Country:US
Practice Address - Phone:757-548-0696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9616235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist