Provider Demographics
NPI:1598454571
Name:MORGANFIELD, OLLISSEA
Entity Type:Individual
Prefix:
First Name:OLLISSEA
Middle Name:
Last Name:MORGANFIELD
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 1:13600 WIMBLEDON LOOP APT C311
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-6125
Mailing Address - Country:US
Mailing Address - Phone:662-820-6887
Mailing Address - Fax:
Practice Address - Street 1:13600 WIMBLEDON LOOP APT C311
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-6125
Practice Address - Country:US
Practice Address - Phone:662-820-6887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202482235Z00000X
MS14283865235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty