Provider Demographics
NPI:1821512013
Name:MORGAN, ELIZABETH DIANA (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DIANA
Last Name:MORGAN
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 1:12628 OTSEGO ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2920
Mailing Address - Country:US
Mailing Address - Phone:574-309-3805
Mailing Address - Fax:
Practice Address - Street 1:12628 OTSEGO ST
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2920
Practice Address - Country:US
Practice Address - Phone:574-309-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP22321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist