Provider Demographics
NPI:1316307507
Name:MORNINGSTAR, MICHELLE ELAINE (MAED)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELAINE
Last Name:MORNINGSTAR
Suffix:
Gender:F
Credentials:MAED
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ELAINE
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, MA
Mailing Address - Street 1:405 FRIENDSHIP AVE
Mailing Address - Street 2:
Mailing Address - City:HELLAM
Mailing Address - State:PA
Mailing Address - Zip Code:17406-9324
Mailing Address - Country:US
Mailing Address - Phone:717-818-1712
Mailing Address - Fax:
Practice Address - Street 1:405 FRIENDSHIP AVE
Practice Address - Street 2:
Practice Address - City:HELLAM
Practice Address - State:PA
Practice Address - Zip Code:17406-9324
Practice Address - Country:US
Practice Address - Phone:717-818-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor