Provider Demographics
NPI:1275117830
Name:MASTROMARINO, MORGAN LEIGH
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:LEIGH
Last Name:MASTROMARINO
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 1:577 E BASELINE RD APT 2024
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1575
Mailing Address - Country:US
Mailing Address - Phone:702-378-0640
Mailing Address - Fax:
Practice Address - Street 1:1745 S ALMA SCHOOL RD STE 145
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3049
Practice Address - Country:US
Practice Address - Phone:480-963-3634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA129102355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant