Provider Demographics
NPI:1336793462
Name:HERATH, MORGAN LEE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:LEE
Last Name:HERATH
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 E INDIAN SCHOOL RD APT 4006
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6064
Mailing Address - Country:US
Mailing Address - Phone:815-354-7266
Mailing Address - Fax:
Practice Address - Street 1:3101 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-2419
Practice Address - Country:US
Practice Address - Phone:602-442-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP11842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP11842OtherAZDHS