Provider Demographics
NPI:1295864049
Name:MORGAN, LISA NELSON (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:NELSON
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 1:2201 S COUNTY ROAD 1128
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79706-4873
Mailing Address - Country:US
Mailing Address - Phone:432-686-1008
Mailing Address - Fax:
Practice Address - Street 1:2201 S COUNTY ROAD 1128
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79706-4873
Practice Address - Country:US
Practice Address - Phone:432-686-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3865235Z00000X
TX101233235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM88121224Medicaid