Provider Demographics
NPI:1134545163
Name:MORMAN, MARVETTA (MA, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:MARVETTA
Middle Name:
Last Name:MORMAN
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:MISS
Other - First Name:MARVETTA
Other - Middle Name:
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC/SLP
Mailing Address - Street 1:3547 E 140TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-4546
Mailing Address - Country:US
Mailing Address - Phone:216-295-1333
Mailing Address - Fax:
Practice Address - Street 1:3547 E 140TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-4546
Practice Address - Country:US
Practice Address - Phone:216-295-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.4206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist