Provider Demographics
NPI:1982004818
Name:MURRAY, MISTY DAWN (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:DAWN
Last Name:MURRAY
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:MISS
Other - First Name:MISTY
Other - Middle Name:DAWN
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC/SLP
Mailing Address - Street 1:1282 WEBER RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-8955
Mailing Address - Country:US
Mailing Address - Phone:740-988-2616
Mailing Address - Fax:
Practice Address - Street 1:100 E 3RD ST
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-8057
Practice Address - Country:US
Practice Address - Phone:740-289-4171
Practice Address - Fax:740-289-4542
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.7552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist