MEDICARE: BRYN-ERINN MOONEY MS 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	SP.12534	OH

General Provider Information

NPI Number	:	1881104834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYN-ERINN MOONEY MS CCC-SLP

Provider Business Mailing Address
First Line	:	8791 BRENT DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-4911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8791 BRENT DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-4911
Country	:	US
Telephone Number	:	513-728-3720
Fax Number	:

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

Provider Enumeration Date	:	10/04/2017
Last Update Date	:	03/17/2018

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