Healthcare Provider Details

I. General information

NPI: 1790272953
Provider Name (Legal Business Name): STEFANIE DAWN MOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEFANIE DAWN MOSS

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

343 W BAGLEY RD
BEREA OH
44017-1370
US

IV. Provider business mailing address

2000 NOBLE DR
WOOSTER OH
44691-5353
US

V. Phone/Fax

Practice location:
  • Phone: 216-373-9244
  • Fax:
Mailing address:
  • Phone: 330-264-3232
  • Fax: 330-264-3879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: