1659524551 NPI number — MRS. ALETHEA DAWN MCMORRIS SLP

Table of content: MRS. ALETHEA DAWN MCMORRIS SLP (NPI 1659524551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659524551 NPI number — MRS. ALETHEA DAWN MCMORRIS SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMORRIS
Provider First Name:
ALETHEA
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MICHIELS
Provider Other First Name:
ALETHEA
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659524551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 DARREN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAGRANGEVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12540-6233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-592-0997
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
65 DARREN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGRANGEVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12540-6233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-592-0997
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  014488 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)