MEDICARE: JAMIE LYNN MOSES-EDMONDS

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	222Q00000X	Developmental Therapist
2	103K00000X	Behavior Analyst	1-18-31739

General Provider Information

NPI Number	:	1598175069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE LYNN MOSES-EDMONDS

Provider Business Mailing Address
First Line	:	21600 OXNARD ST STE 1800
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-7807
Country	:	US
Telephone Number	:	818-345-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	7351 W CHARLESTON BLVD STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1572
Country	:	US
Telephone Number	:	702-470-0621
Fax Number	:

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

Provider Enumeration Date	:	05/05/2014
Last Update Date	:	10/15/2018

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