Provider Demographics
NPI:1932494184
Name:HICKEY, MORGAN L (SLP)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:L
Last Name:HICKEY
Suffix:
Gender:F
Credentials: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 236
Mailing Address - Street 2:
Mailing Address - City:FLAGLER
Mailing Address - State:CO
Mailing Address - Zip Code:80815-0236
Mailing Address - Country:US
Mailing Address - Phone:575-649-9796
Mailing Address - Fax:
Practice Address - Street 1:304 KENDALL AVE
Practice Address - Street 2:
Practice Address - City:FLAGLER
Practice Address - State:CO
Practice Address - Zip Code:80815
Practice Address - Country:US
Practice Address - Phone:575-649-9796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105898235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist