Provider Demographics
NPI:1316580517
Name:MORGAN, KELLY NICOLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:NICOLE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 HEARTLAND TRL
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1982
Mailing Address - Country:US
Mailing Address - Phone:608-294-6008
Mailing Address - Fax:608-824-2675
Practice Address - Street 1:744 HEARTLAND TRL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1982
Practice Address - Country:US
Practice Address - Phone:608-294-6008
Practice Address - Fax:608-824-2675
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3147103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1316580517Medicaid