Provider Demographics
NPI:1326252115
Name:MORGAN, GARY L (MS CCC-A)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:L
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MS CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 REGENT ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4963
Mailing Address - Country:US
Mailing Address - Phone:608-238-1199
Mailing Address - Fax:608-238-1985
Practice Address - Street 1:4510 REGENT ST
Practice Address - Street 2:SUITE D
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4963
Practice Address - Country:US
Practice Address - Phone:608-238-1199
Practice Address - Fax:608-238-1985
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI118-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41117500Medicaid
WI41117500Medicaid