Provider Demographics
NPI:1245765338
Name:MORRISON, KACEY
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:MORRISON
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 1:9101 141ST ST W
Mailing Address - Street 2:
Mailing Address - City:TAYLOR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:61284-9336
Mailing Address - Country:US
Mailing Address - Phone:708-912-2271
Mailing Address - Fax:
Practice Address - Street 1:9101 141ST ST W
Practice Address - Street 2:
Practice Address - City:TAYLOR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:61284-9336
Practice Address - Country:US
Practice Address - Phone:708-912-2271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960033492255A2300X
IA0773422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer