Provider Demographics
NPI:1922362169
Name:MCCONNAUGHHAY, MORGAN (SLP)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:MCCONNAUGHHAY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MORGAN
Other - Middle Name:
Other - Last Name:BOGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:1440 NYMPH CT APT 1
Mailing Address - Street 2:
Mailing Address - City:NORTH POLE
Mailing Address - State:AK
Mailing Address - Zip Code:99705-8502
Mailing Address - Country:US
Mailing Address - Phone:815-488-2162
Mailing Address - Fax:907-452-4263
Practice Address - Street 1:1327 KALAKAKET ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4917
Practice Address - Country:US
Practice Address - Phone:907-452-4517
Practice Address - Fax:907-452-4263
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK454235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1585543Medicaid