Provider Demographics
NPI:1912610114
Name:GUSTAFSON, MORGAN CHANNING (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:CHANNING
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2884 ARRENDONDA DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32738-2205
Mailing Address - Country:US
Mailing Address - Phone:804-314-7354
Mailing Address - Fax:
Practice Address - Street 1:1550 JESS PARRISH CT
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-2147
Practice Address - Country:US
Practice Address - Phone:804-314-7354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist