Healthcare Provider Details

I. General information

NPI: 1558642579
Provider Name (Legal Business Name): COLLEEN IRELAND MORGAN M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN MARY IRELAND

II. Dates (important events)

Enumeration Date: 09/03/2011
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 WILLOW OAKS CORPORATE DR STE 300
FAIRFAX VA
22031-4518
US

IV. Provider business mailing address

8280 WILLOW OAKS CORPORATE DR STE 300
FAIRFAX VA
22031-4518
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-4300
  • Fax: 571-665-6771
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number07811
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number000914
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202007907
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: