Provider Demographics
NPI:1891129789
Name:MORRISON, JACKLYN (MA CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JACKLYN
Middle Name:
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 1:24 ANNANDALE RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2410
Mailing Address - Country:US
Mailing Address - Phone:631-678-8921
Mailing Address - Fax:
Practice Address - Street 1:24 ANNANDALE RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2410
Practice Address - Country:US
Practice Address - Phone:631-678-8921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023055-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist