Provider Demographics
NPI:1932292745
Name:MORRISON, THERESA JEAN (MS, CCC/SLP)
Entity Type:Individual
Prefix:MR
First Name:THERESA
Middle Name:JEAN
Last Name:MORRISON
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 1:1301 MEMORIAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2068
Mailing Address - Country:US
Mailing Address - Phone:304-267-0986
Mailing Address - Fax:
Practice Address - Street 1:2000 FOUNDATION WAY
Practice Address - Street 2:SUITE 1200
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9003
Practice Address - Country:US
Practice Address - Phone:304-264-1214
Practice Address - Fax:304-264-1331
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVSLP-0491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0154141-000Medicaid