MEDICARE: MRS. MARVETTA MORMAN MA, CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP.4206	OH

General Provider Information

NPI Number	:	1134545163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARVETTA MORMAN MA, CCC/SLP

Provider Business Mailing Address
First Line	:	3547 E 140TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-4546
Country	:	US
Telephone Number	:	216-295-1333
Fax Number	:

Provider Business Practice Location Address
First Line	:	3547 E 140TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-4546
Country	:	US
Telephone Number	:	216-295-1333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2014
Last Update Date	:	03/14/2014

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Directions to “ MRS. MARVETTA MORMAN MA, CCC/SLP” Practice Location

Language	Start Address	Practice Location

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