Provider Demographics
NPI:1639709991
Name:MORSE, KELLIE SUZANNE (HIS)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:SUZANNE
Last Name:MORSE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:SUZANNE
Other - Last Name:MORSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HIS
Mailing Address - Street 1:188 EVERGREEN DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-7066
Mailing Address - Country:US
Mailing Address - Phone:580-224-1090
Mailing Address - Fax:
Practice Address - Street 1:1316 12TH AVE NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1285
Practice Address - Country:US
Practice Address - Phone:580-220-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1219237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist