Provider Demographics
NPI:1457928533
Name:BERGGREN, MORGAN LINDSEY
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:LINDSEY
Last Name:BERGGREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5518 HIGHWAY 178 W
Mailing Address - Street 2:
Mailing Address - City:RED BANKS
Mailing Address - State:MS
Mailing Address - Zip Code:38661-9629
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5271 GETWELL RD STE A
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-9608
Practice Address - Country:US
Practice Address - Phone:662-349-3512
Practice Address - Fax:662-772-5925
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS235Z00000X
MSS-4812235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist