MEDICARE: JENNA MOE M.A. C.C.C.-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SL010014	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	574931	OTHER	GROUP HIGHMARK PROVIDER ID
2	1982671467	OTHER	GROUP NPI
3	251553131	OTHER	GROUP TAX ID

General Provider Information

NPI Number	:	1427351196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA MOE M.A. C.C.C.-SLP

Provider Business Mailing Address
First Line	:	250 MOUNT LEBANON BLVD
Second Line	:	SUITE 411
City	:	PITTSBURGH
State	:	PA
Zip	:	15234-1252
Country	:	US
Telephone Number	:	412-563-2434
Fax Number	:	412-563-7610

Provider Business Practice Location Address
First Line	:	250 MOUNT LEBANON BLVD
Second Line	:	SUITE 411
City	:	PITTSBURGH
State	:	PA
Zip	:	15234-1252
Country	:	US
Telephone Number	:	412-563-2434
Fax Number	:	412-563-7610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2010
Last Update Date	:	12/17/2010

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Directions to “ JENNA MOE M.A. C.C.C.-SLP” Practice Location

Language	Start Address	Practice Location

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