Provider Demographics
NPI:1295909588
Name:MORGAN, PATRICIA ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:MORGAN
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 1:18618 AMONSON ROAD
Mailing Address - Street 2:POST OFFICE BOX 671243
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99616
Mailing Address - Country:US
Mailing Address - Phone:907-512-2751
Mailing Address - Fax:
Practice Address - Street 1:18618 AMONSON ROAD
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567
Practice Address - Country:US
Practice Address - Phone:907-942-3413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020986Medicaid
AK1031197Medicaid