MEDICARE: EMILY MOONEY CCC 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	LL 00003378	WA

General Provider Information

NPI Number	:	1588890966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MOONEY CCC SLP

Provider Business Mailing Address
First Line	:	4050 S 212TH CT
Second Line	:	UNIT B
City	:	SEATAC
State	:	WA
Zip	:	98198-4237
Country	:	US
Telephone Number	:	253-277-1222
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 S 212TH CT
Second Line	:	UNIT B
City	:	SEATAC
State	:	WA
Zip	:	98198-4237
Country	:	US
Telephone Number	:	253-277-1222
Fax Number	:

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

Provider Enumeration Date	:	05/30/2009
Last Update Date	:	05/30/2009

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Directions to “ EMILY MOONEY CCC SLP” Practice Location

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