Provider Demographics
NPI:1508149485
Name:MORRISSEY, DAN
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:MORRISSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CORPORATE DR
Mailing Address - Street 2:STE 1
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916-1281
Mailing Address - Country:US
Mailing Address - Phone:920-887-9658
Mailing Address - Fax:
Practice Address - Street 1:29134 EVERGREEN DR
Practice Address - Street 2:#3
Practice Address - City:WATERFORD
Practice Address - State:WI
Practice Address - Zip Code:53185-5111
Practice Address - Country:US
Practice Address - Phone:262-514-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI136260237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist