Provider Demographics
NPI:1790358737
Name:MORRISON, KATIE LYN (MA, CCC- SLP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYN
Last Name:MORRISON
Suffix:
Gender:F
Credentials:MA, CCC- SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 PALM TERRACE LOOP
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-8655
Mailing Address - Country:US
Mailing Address - Phone:631-559-5047
Mailing Address - Fax:
Practice Address - Street 1:2126 HIGHWAY 9 E STE C4
Practice Address - Street 2:
Practice Address - City:LONGS
Practice Address - State:SC
Practice Address - Zip Code:29568-5753
Practice Address - Country:US
Practice Address - Phone:843-734-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist