Provider Demographics
NPI:1205409075
Name:MORGAN, ALLIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:
Last Name:MORGAN
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 1:1732 KING ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:SAREPTA
Mailing Address - State:LA
Mailing Address - Zip Code:71071-2334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1732 KING ORCHARD RD
Practice Address - Street 2:
Practice Address - City:SAREPTA
Practice Address - State:LA
Practice Address - Zip Code:71071-2334
Practice Address - Country:US
Practice Address - Phone:318-465-0497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8404235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist