Healthcare Provider Details

I. General information

NPI: 1699652180
Provider Name (Legal Business Name): CAYLEN MOYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 S 5TH ST
SAINT JOSEPH IL
61873-9073
US

IV. Provider business mailing address

1103 E WILLARD ST APT A
URBANA IL
61801-6961
US

V. Phone/Fax

Practice location:
  • Phone: 217-469-2291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: