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NPI Code Detail

MEDICARE: STORMY LYNN MOSSON

MEDICARE: STORMY LYNN MOSSON
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1558158923
Entity Type Code : Individual
Provider Name (Legal Business Name) : STORMY LYNN MOSSON
Provider Business Mailing Address
First Line : 2413 N TALMAN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-0610
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1657 W CORTLAND ST
Second Line :
City : CHICAGO
State : IL
Zip : 60622-1119
Country : US
Telephone Number : 877-486-4140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2025
Last Update Date : 04/21/2025

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