Provider Demographics
NPI:1730736646
Name:RANDEL, MORGAN IVEY (MCD CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MORGAN
Middle Name:IVEY
Last Name:RANDEL
Suffix:
Gender:F
Credentials:MCD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 SOUTHEND CROSSING LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-6711
Mailing Address - Country:US
Mailing Address - Phone:318-393-2394
Mailing Address - Fax:
Practice Address - Street 1:3369 DEAL RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-4259
Practice Address - Country:US
Practice Address - Phone:704-875-7112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist