Provider Demographics
NPI:1619533528
Name:WIDDOWSON, MORGAN NICOLE
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:NICOLE
Last Name:WIDDOWSON
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 1:5604 VIRGINIA BEACH BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5631
Mailing Address - Country:US
Mailing Address - Phone:757-455-5000
Mailing Address - Fax:757-319-4142
Practice Address - Street 1:10514 RACETRACK RD STE G
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3241
Practice Address - Country:US
Practice Address - Phone:410-973-2301
Practice Address - Fax:410-973-2305
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000705235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD483106300Medicaid