Provider Demographics
NPI:1912025313
Name:MORRIS, PHAEDRIA JEAN (MS, CCC,SLP)
Entity Type:Individual
Prefix:MS
First Name:PHAEDRIA
Middle Name:JEAN
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MS, CCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 GARNET ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-5806
Mailing Address - Country:US
Mailing Address - Phone:501-623-8659
Mailing Address - Fax:
Practice Address - Street 1:135 SCHOOL DRIVE
Practice Address - Street 2:
Practice Address - City:ODEN
Practice Address - State:AR
Practice Address - Zip Code:71961
Practice Address - Country:US
Practice Address - Phone:870-326-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist