Provider Demographics
NPI:1467027839
Name:MOSS, MORGAN LAINE (AUD)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:LAINE
Last Name:MOSS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 BLAND DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77611-3705
Mailing Address - Country:US
Mailing Address - Phone:409-782-0304
Mailing Address - Fax:
Practice Address - Street 1:740 HOSPITAL DR STE 310
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4666
Practice Address - Country:US
Practice Address - Phone:409-981-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81267231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist