Provider Demographics
NPI:1417476375
Name:RIVERA, MORGAN (MS CCC-SLP/L)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MS CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 BRYAN ST APT C
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-2764
Mailing Address - Country:US
Mailing Address - Phone:815-716-6841
Mailing Address - Fax:
Practice Address - Street 1:300 E MONROE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4028
Practice Address - Country:US
Practice Address - Phone:309-827-6031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.013140235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist