Provider Demographics
NPI:1376240507
Name:MUDD, MORGAN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:MUDD
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 HIGHLAND LICK RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-9275
Mailing Address - Country:US
Mailing Address - Phone:270-893-5600
Mailing Address - Fax:
Practice Address - Street 1:314 HIGHLAND LICK RD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-9275
Practice Address - Country:US
Practice Address - Phone:270-893-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY272651235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist