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NPI Code Detail

MEDICARE: MADISON MOSER CT

MEDICARE: MADISON MOSER CT
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
1101Y00000XCounselorC.2607791OH
2171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720760317
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON MOSER CT
Provider Business Mailing Address
First Line : 45875 BELL SCHOOL RD STE B
Second Line :
City : EAST LIVERPOOL
State : OH
Zip : 43920-8728
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 45875 BELL SCHOOL RD STE B
Second Line :
City : EAST LIVERPOOL
State : OH
Zip : 43920-8728
Country : US
Telephone Number : 330-397-6007
Fax Number : 234-254-5655
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2023
Last Update Date : 01/15/2026

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1821959057 — JACQUELYNN MARIE GRINNELL
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43920-8728
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Practice Location Address:
45875 BELL SCHOOL RD STE B
EAST LIVERPOOL, OH
43920-8728
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Directions to “ MADISON MOSER CT” Practice Location

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