=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902672108
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MORSE SPEECH THERAPY AND EDUCATIONAL SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2023
-----------------------------------------------------
Last Update Date | 11/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 GRAND OAKS WAY UNIT 326
-----------------------------------------------------
City | MARTINEZ
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30907-0017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-309-4391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 GRAND OAKS WAY UNIT 326
-----------------------------------------------------
City | MARTINEZ
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30907-0017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-309-4391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | STEPHANIE MORSE
-----------------------------------------------------
Credential | M. ED., CCC-SLP
-----------------------------------------------------
Telephone | 706-309-4391
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------