Provider Demographics
NPI:1164893293
Name:MORRIS SPEECH THERAPY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MORRIS SPEECH THERAPY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMAREST
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC SLP,CBIS
Authorized Official - Phone:201-787-6786
Mailing Address - Street 1:8 HUMPHREY ROAD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960
Mailing Address - Country:US
Mailing Address - Phone:201-787-6786
Mailing Address - Fax:
Practice Address - Street 1:155 ROUTE 46
Practice Address - Street 2:BUILDING F
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046
Practice Address - Country:US
Practice Address - Phone:201-787-6786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00582700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ309839Medicare UPIN