Healthcare Provider Details

I. General information

NPI: 1528703758
Provider Name (Legal Business Name): LENDA MORRIS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 05/02/2022
Certification Date: 05/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 QUILLIAN ST
CLEVELAND GA
30528-1464
US

IV. Provider business mailing address

810 WINSCAPE LN
CORNELIA GA
30531-5062
US

V. Phone/Fax

Practice location:
  • Phone: 706-865-6800
  • Fax:
Mailing address:
  • Phone: 706-990-0972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP004895
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: