Provider Demographics
NPI:1144626367
Name:MORALES, ILYANA R (MS SLP)
Entity type:Individual
Prefix:
First Name:ILYANA
Middle Name:R
Last Name:MORALES
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2241
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-0063
Mailing Address - Country:US
Mailing Address - Phone:770-464-6254
Mailing Address - Fax:
Practice Address - Street 1:4116 PRESTON POINTE WAY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6145
Practice Address - Country:US
Practice Address - Phone:770-464-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-16
Last Update Date:2020-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010613235Z00000X
PR0003012235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist