Provider Demographics
NPI:1740645183
Name:ROTHSTEIN, MORGAN (MS CC-SLP)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:ROTHSTEIN
Suffix:
Gender:F
Credentials:MS CC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2453 US HIGHWAY 17 STE G
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-5960
Mailing Address - Country:US
Mailing Address - Phone:912-445-5612
Mailing Address - Fax:
Practice Address - Street 1:2453 US HIGHWAY 17 STE G
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-5960
Practice Address - Country:US
Practice Address - Phone:912-445-5612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2020-07-09
Deactivation Date:2020-06-19
Deactivation Code:
Reactivation Date:2020-07-08
Provider Licenses
StateLicense IDTaxonomies
GA14317052235Z00000X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist