=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801213384
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGIE MORAGNE SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/24/2014
-----------------------------------------------------
Last Update Date | 03/24/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5171 STEVENSON ST
-----------------------------------------------------
City | RICHMOND HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44143-2761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-870-3071
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5171 STEVENSON ST
-----------------------------------------------------
City | RICHMOND HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44143-2761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-870-3071
-----------------------------------------------------
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 | SP6485
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------