Healthcare Provider Details

I. General information

NPI: 1609753474
Provider Name (Legal Business Name): ASHLEY MOYAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 W 26TH ST
ERIE PA
16508-1402
US

IV. Provider business mailing address

1330 W 26TH ST
ERIE PA
16508-1402
US

V. Phone/Fax

Practice location:
  • Phone: 814-451-2238
  • Fax:
Mailing address:
  • Phone: 814-451-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW141909
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: