Provider Demographics
NPI:1831485044
Name:MORRIS, RICHARD JACK (PHD, SLP/CCC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JACK
Last Name:MORRIS
Suffix:
Gender:M
Credentials:PHD, SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 HONORS WAY
Mailing Address - Street 2:FLORIDA STATE UNIVERSITY
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-1200
Mailing Address - Country:US
Mailing Address - Phone:850-644-2238
Mailing Address - Fax:850-644-4898
Practice Address - Street 1:127 HONORS WAY
Practice Address - Street 2:FLORIDA STATE UNIVERSITY
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-1200
Practice Address - Country:US
Practice Address - Phone:850-644-2238
Practice Address - Fax:850-644-4898
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA572235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA572OtherLICENSE