Basic Information
| Provider Information | |||||||||
| NPI: | 1841449618 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORRIS | ||||||||
| FirstName: | RANDY | ||||||||
| MiddleName: | STEVEN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | SPEECH PATHOLOGIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6902 W 51ST ST | ||||||||
| Address2: | #213 | ||||||||
| City: | MISSION | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662021418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136717517 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2900 CHARLEVOIX DR SE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495467085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006341077 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2008 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 02045 | MO | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 813 | KS | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.