MEDICARE: ALLISON ELIZABETH MOENNIG M.S.

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	:	1871142414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON ELIZABETH MOENNIG M.S.

Provider Business Mailing Address
First Line	:	1201 MAIN ST
Second Line	:
City	:	GERMANTOWN
State	:	IL
Zip	:	62245-2712
Country	:	US
Telephone Number	:	618-520-2795
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 MAIN ST
Second Line	:
City	:	GERMANTOWN
State	:	IL
Zip	:	62245-2712
Country	:	US
Telephone Number	:	618-520-2795
Fax Number	:

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

Provider Enumeration Date	:	09/06/2019
Last Update Date	:	09/06/2019

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