MEDICARE: MELBA A. MORENO-LOFGREN S.L.P.

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	19858	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8T7491	OTHER	TX	BLUE CROSS BLUE SHIELD TX

General Provider Information

NPI Number	:	1598940835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELBA A. MORENO-LOFGREN S.L.P.

Provider Business Mailing Address
First Line	:	647 SARALVO RD
Second Line	:
City	:	MIDLOTHIAN
State	:	TX
Zip	:	76065-5780
Country	:	US
Telephone Number	:	817-913-4107
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 HULEN ST STE 100
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76107-7269
Country	:	US
Telephone Number	:	817-569-4039
Fax Number	:

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

Provider Enumeration Date	:	01/06/2008
Last Update Date	:	07/17/2023

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Directions to “ MELBA A. MORENO-LOFGREN S.L.P.” Practice Location

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