MEDICARE: THE THERAPY CLUBHOUSE

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

General Provider Information

NPI Number	:	1285400143
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE THERAPY CLUBHOUSE

Provider Business Mailing Address
First Line	:	3405 W TRUMAN BLVD STE 210B
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-5861
Country	:	US
Telephone Number	:	573-299-0363
Fax Number	:

Provider Business Practice Location Address
First Line	:	3405 W TRUMAN BLVD STE 210B
Second Line	:
City	:	JEFFERSON CITY
State	:	MO
Zip	:	65109-5861
Country	:	US
Telephone Number	:	573-299-0363
Fax Number	:

Authorized Official
Title or Position	:	OWNER/SPEECH-LANGUAGE PATHOLOGIST
Name	:	MRS. BRIANNE R MORGAN
Credential	:	MHS CCC-SLP
Telephone Number	:	573-299-0363

Provider Enumeration Date	:	11/30/2023
Last Update Date	:	11/30/2023

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Directions to “THE THERAPY CLUBHOUSE ” Practice Location

Language	Start Address	Practice Location

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