Basic Information
| Provider Information | |||||||||
| NPI: | 1407387095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | KACIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS, CCC-SLP/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2641 CAMBRIA ST | ||||||||
| Address2: | |||||||||
| City: | FALLENTIMBER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166399537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145535355 | ||||||||
| FaxNumber: | 8143422755 | ||||||||
| Practice Location | |||||||||
| Address1: | 2641 CAMBRIA ST | ||||||||
| Address2: | |||||||||
| City: | FALLENTIMBER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166399537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145535355 | ||||||||
| FaxNumber: | 8143422755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2017 | ||||||||
| LastUpdateDate: | 03/24/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SL013375 | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | SL013375 | 01 | PA | STATE OF PA | OTHER |