MEDICARE: THERESA MOUREY

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1619339041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA MOUREY

Provider Business Mailing Address
First Line	:	20650 GLENN ST.
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68022
Country	:	US
Telephone Number	:	402-289-2579
Fax Number	:

Provider Business Practice Location Address
First Line	:	20650 GLENN ST.
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68022-2324
Country	:	US
Telephone Number	:	402-289-2579
Fax Number	:

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

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	03/24/2016

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Directions to “ THERESA MOUREY ” Practice Location

Language	Start Address	Practice Location

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