Provider Demographics
NPI:1518612639
Name:VAN MATER, MORGAN ELYSE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:ELYSE
Last Name:VAN MATER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 TEMPLIN WAY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5904
Mailing Address - Country:US
Mailing Address - Phone:214-673-7333
Mailing Address - Fax:
Practice Address - Street 1:2941 MOLLIMAR DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6319
Practice Address - Country:US
Practice Address - Phone:214-673-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-16
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist