Provider Demographics
NPI:1386091601
Name:MORGAN, ELISSA SMITH (M A CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:SMITH
Last Name:MORGAN
Suffix:
Gender:F
Credentials:M A CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2651 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2551
Mailing Address - Country:US
Mailing Address - Phone:513-363-0265
Mailing Address - Fax:
Practice Address - Street 1:2651 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2551
Practice Address - Country:US
Practice Address - Phone:513-363-0265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 5706235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist