MEDICARE: MISS MELISSA MOSS

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	1041C0700X	Clinical Social Worker	7133656-3501	UT
2	1041S0200X	School Social Worker

General Provider Information

NPI Number	:	1528362449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MELISSA MOSS

Provider Business Mailing Address
First Line	:	54 N BRISTOL DR
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-1307
Country	:	US
Telephone Number	:	435-760-0753
Fax Number	:

Provider Business Practice Location Address
First Line	:	965 S MAIN ST
Second Line	:	STE 5
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-4309
Country	:	US
Telephone Number	:	435-760-0753
Fax Number	:

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

Provider Enumeration Date	:	01/06/2011
Last Update Date	:	12/14/2024

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Directions to “ MISS MELISSA MOSS ” Practice Location

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