Provider Demographics
NPI:1912033218
Name:MORGAN, KATHLEEN GERISE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:GERISE
Last Name:MORGAN
Suffix:
Gender:F
Credentials: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:PO BOX 110434
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0434
Mailing Address - Country:US
Mailing Address - Phone:907-563-1167
Mailing Address - Fax:907-563-1169
Practice Address - Street 1:4401 BUSINESS PARK BLVD # N26
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7172
Practice Address - Country:US
Practice Address - Phone:907-563-1167
Practice Address - Fax:907-563-1169
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKSP 2194Medicaid