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General NPI Number Information
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NPI Number | 1831324433
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Entity Type | Individual
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Provider Name | JEFFREY GLENN MOULTON M.S., CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 05/27/2009
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 7025 SIERRA CLUB CIR APT 6105
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City | NAPLES
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State | FL
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Zip | 34113-7360
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Country | US
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Telephone | 734-351-8503
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Fax |
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Provider Business Mailing Address
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Address Line | 7025 SIERRA CLUB CIR APT 6105
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City | NAPLES
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State | FL
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Zip | 34113-7360
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Country | US
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Telephone | 734-351-8503
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA15131
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License Number State | FL
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Taxonomy #2
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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 | MI
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 7101004036
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License Number State | MI
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