=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346866191
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MORGAN SULLIVAN M.S. CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2020
-----------------------------------------------------
Last Update Date | 01/10/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 589 LE GRANDE ROAD
-----------------------------------------------------
City | CHASE CITY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23924-2392
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-233-2390
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 589 LE GRANDE ROAD
-----------------------------------------------------
City | BOYDTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 2204000507
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------