=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093084121
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WHITNEY ALISE MOSLEY M.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2011
-----------------------------------------------------
Last Update Date | 12/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3600 CANTRELL RD SUITE 205
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72202-1893
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-526-8008
-----------------------------------------------------
Fax | 501-526-8009
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4301 W MARKHAM ST SLOT, #783
-----------------------------------------------------
City | LITTLE ROCK
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72205-7101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-614-2006
-----------------------------------------------------
Fax | 501-526-6562
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SP#P8513
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------