MEDICARE: ABBY CECELIA MORAN CCC-SLP

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	13953310-4102	UT

General Provider Information

NPI Number	:	1902595275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABBY CECELIA MORAN CCC-SLP

Provider Business Mailing Address
First Line	:	6409 CITY WEST PKWY STE 206
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7846
Country	:	US
Telephone Number	:	952-500-8871
Fax Number	:

Provider Business Practice Location Address
First Line	:	365 W 1550 N STE H
Second Line	:
City	:	LAYTON
State	:	UT
Zip	:	84041-2279
Country	:	US
Telephone Number	:	801-618-7903
Fax Number	:

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

Provider Enumeration Date	:	05/03/2023
Last Update Date	:	06/09/2026

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