Provider Demographics
NPI:1528426673
Name:MORGAN, BERVESSA (MSCCC-SLP)
Entity type:Individual
Prefix:MS
First Name:BERVESSA
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10312 HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-7614
Mailing Address - Country:US
Mailing Address - Phone:813-741-1423
Mailing Address - Fax:
Practice Address - Street 1:10312 HOLLAND RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-7614
Practice Address - Country:US
Practice Address - Phone:813-741-1423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist