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General NPI Number Information
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NPI Number | 1467061416
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Entity Type | Individual
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Provider Name | MR. DERRICK LASHAWN MORTON JR.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2020
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Last Update Date | 10/22/2023
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Provider Practice Location Address
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Address Line | 13886 CITRUS GROVE BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33412-3212
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Country | US
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Telephone | 216-357-8643
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Fax |
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Provider Business Mailing Address
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Address Line | 13886 CITRUS GROVE BLVD
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City | WEST PALM BEACH
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State | FL
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Zip | 33412-3212
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Country | US
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Telephone | 216-357-8643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP.12975
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA21039
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License Number State | FL
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