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General NPI Number Information
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NPI Number | 1417365982
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Entity Type | Individual
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Provider Name | MARY JO MOESCHL PHD
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Gender | Female
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 12/14/2025
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Provider Practice Location Address
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Address Line | 9340 NE 76TH ST
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City | VANCOUVER
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State | WA
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Zip | 98662-3721
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Country | US
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Telephone | 360-253-4912
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Fax | 360-253-5170
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Provider Business Mailing Address
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Address Line | 1658 DISCOVERY ST
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City | WALLA WALLA
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State | WA
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Zip | 99362-5010
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Country | US
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Telephone | 509-240-7150
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60049899
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License Number State | WA
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