Provider Demographics
NPI:1861962169
Name:MORRIS-STEPHENS, CHANEL MERCEDES (MA)
Entity type:Individual
Prefix:MRS
First Name:CHANEL
Middle Name:MERCEDES
Last Name:MORRIS-STEPHENS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 GREEN ISLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-7352
Mailing Address - Country:US
Mailing Address - Phone:770-714-0642
Mailing Address - Fax:
Practice Address - Street 1:5635 GREEN ISLAND BLVD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-7352
Practice Address - Country:US
Practice Address - Phone:770-714-0642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty