Healthcare Provider Details

I. General information

NPI: 1821500653
Provider Name (Legal Business Name): DANA MOSER PHD, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 ASHER AVE STE 600
LITTLE ROCK AR
72204-7871
US

IV. Provider business mailing address

6106 REMINGTON DR
BRYANT AR
72022-7526
US

V. Phone/Fax

Practice location:
  • Phone: 501-569-3155
  • Fax:
Mailing address:
  • Phone: 832-627-9964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4294
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: