Provider Demographics
NPI:1265004188
Name:ZEDALIS, MORGAHN DEEANN (MSW,QMHP)
Entity Type:Individual
Prefix:
First Name:MORGAHN
Middle Name:DEEANN
Last Name:ZEDALIS
Suffix:
Gender:F
Credentials:MSW,QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CARMI
Mailing Address - State:IL
Mailing Address - Zip Code:62821-2258
Mailing Address - Country:US
Mailing Address - Phone:618-382-7311
Mailing Address - Fax:618-382-7552
Practice Address - Street 1:1705 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:CARMI
Practice Address - State:IL
Practice Address - Zip Code:62821-2258
Practice Address - Country:US
Practice Address - Phone:618-382-7311
Practice Address - Fax:618-382-7552
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health