Provider Demographics
NPI:1922122191
Name:MORRISON, ANGELA SHEPHERD (SPEECH LANGUAGE PATH)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:SHEPHERD
Last Name:MORRISON
Suffix:
Gender:F
Credentials:SPEECH LANGUAGE PATH
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 1008
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556-1008
Mailing Address - Country:US
Mailing Address - Phone:870-251-2297
Mailing Address - Fax:870-251-4039
Practice Address - Street 1:70 SCOTT DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-9796
Practice Address - Country:US
Practice Address - Phone:870-251-2297
Practice Address - Fax:870-251-4039
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5U184Medicare UPIN