Provider Demographics
NPI:1629106083
Name:MORGAN, CAROL (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 OUACHITA ST
Mailing Address - Street 2:BOX 3763
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71998-0001
Mailing Address - Country:US
Mailing Address - Phone:870-245-5213
Mailing Address - Fax:870-245-4657
Practice Address - Street 1:410 OUACHITA ST
Practice Address - Street 2:BOX 3763
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71998-0001
Practice Address - Country:US
Practice Address - Phone:870-245-5213
Practice Address - Fax:870-245-4657
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR333235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR01025746OtherASHA CERTIFICATION