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General NPI Number Information
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NPI Number | 1053093377
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Entity Type | Organization
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Legal Business Name | MOSS SLP THERAPY LLC
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Dates
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Enumeration Date | 08/04/2023
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 11080 LOTHMORE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32221-3873
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Country | US
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Telephone | 817-727-3226
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Fax |
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Provider Business Mailing Address
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Address Line | 11080 LOTHMORE RD
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City | JACKSONVILLE
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State | FL
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Zip | 32221-3873
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Country | US
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Telephone | 817-727-3226
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Fax |
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST, OWNER
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Name | ELIZABETH E MOSS
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Credential | MS, CCC-SLP, CBIS
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Telephone | 817-727-3226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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