MEDICARE: MARCELON ALEXZANDER MOSLEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	2405-4100-129M	IL

General Provider Information

NPI Number	:	1154271146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELON ALEXZANDER MOSLEY

Provider Business Mailing Address
First Line	:	1142 E REYNOLDS ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-8410
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1142 E REYNOLDS ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-8410
Country	:	US
Telephone Number	:	217-502-5049
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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