Provider Demographics
NPI:1558668913
Name:MORRIS, MATTHEW L (HIS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:L
Last Name:MORRIS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7771 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-6742
Mailing Address - Country:US
Mailing Address - Phone:317-375-0979
Mailing Address - Fax:317-354-9846
Practice Address - Street 1:7771 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-6742
Practice Address - Country:US
Practice Address - Phone:317-375-0979
Practice Address - Fax:317-354-9846
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001336A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist