Provider Demographics
NPI:1841495025
Name:MORTON, CHERYL LEE (MSCCC-SLP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LEE
Last Name:MORTON
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7027 W BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-9544
Mailing Address - Country:US
Mailing Address - Phone:623-979-6505
Mailing Address - Fax:
Practice Address - Street 1:2435 E SOUTHERN AVE
Practice Address - Street 2:SUITE #7
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7628
Practice Address - Country:US
Practice Address - Phone:480-345-2012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP1010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SLP1010OtherAZ STATE LICENSE