MEDICARE: BETHANY MORGADO CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	18.006777	CT
2	235Z00000X	Speech-Language Pathologist	SLP012349	GA

General Provider Information

NPI Number	:	1225851587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY MORGADO CCC-SLP

Provider Business Mailing Address
First Line	:	339 ANGIER AVE NE APT 1
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-1005
Country	:	US
Telephone Number	:	719-963-6849
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 MIAMI CIR NE STE 680
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-3015
Country	:	US
Telephone Number	:	770-302-6902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	11/05/2024

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Directions to “ BETHANY MORGADO CCC-SLP” Practice Location

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