Healthcare Provider Details

I. General information

NPI: 1487854071
Provider Name (Legal Business Name): CONSUELA TORTORICH MORRIS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GREEN OAK LN
WHITE HALL AR
71602-5407
US

IV. Provider business mailing address

800 GREEN OAK LN
WHITE HALL AR
71602-5407
US

V. Phone/Fax

Practice location:
  • Phone: 870-247-3919
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA76
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberA76
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberA76
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberA76
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: