Provider Demographics
NPI:1861965782
Name:MORRIS, VIRGINIA BROOKE (MS CCC SLP)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:BROOKE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MORNING DOVE LN
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-8467
Mailing Address - Country:US
Mailing Address - Phone:270-779-7174
Mailing Address - Fax:
Practice Address - Street 1:111 MORNING DOVE LN
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-8467
Practice Address - Country:US
Practice Address - Phone:270-779-7174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004501A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist