Provider Demographics
NPI:1720546963
Name:O'CONNOR-MORGAN, ANITA MARIE (MA-CCC, MM)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:MARIE
Last Name:O'CONNOR-MORGAN
Suffix:
Gender:F
Credentials:MA-CCC, MM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3643 DAWES AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-5510
Mailing Address - Country:US
Mailing Address - Phone:616-241-4919
Mailing Address - Fax:
Practice Address - Street 1:3643 DAWES AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-5510
Practice Address - Country:US
Practice Address - Phone:616-241-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101003896235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7101003896OtherMICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS