Provider Demographics
NPI:1518254374
Name:MORRELL, GRACE LIZABETH
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:LIZABETH
Last Name:MORRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 775
Mailing Address - Street 2:30 PORTLAND AVE
Mailing Address - City:MANZANITA
Mailing Address - State:OR
Mailing Address - Zip Code:97130-0775
Mailing Address - Country:US
Mailing Address - Phone:503-368-7960
Mailing Address - Fax:
Practice Address - Street 1:610 HIGH ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2241
Practice Address - Country:US
Practice Address - Phone:503-657-8903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11615235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist