Provider Demographics
NPI:1699196493
Name:DALTON, MORGAN RENEE (SLP-CCC)
Entity Type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:RENEE
Last Name:DALTON
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 WALKLEY HILL RD
Mailing Address - Street 2:
Mailing Address - City:HADDAM
Mailing Address - State:CT
Mailing Address - Zip Code:06438-1011
Mailing Address - Country:US
Mailing Address - Phone:860-608-6242
Mailing Address - Fax:
Practice Address - Street 1:139 WALKLEY HILL RD
Practice Address - Street 2:
Practice Address - City:HADDAM
Practice Address - State:CT
Practice Address - Zip Code:06438
Practice Address - Country:US
Practice Address - Phone:860-608-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4912235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist