Provider Demographics
NPI:1093368466
Name:MOSLEY, CORNETTA LASHELL
Entity Type:Individual
Prefix:
First Name:CORNETTA
Middle Name:LASHELL
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-434-3626
Mailing Address - Fax:251-445-2464
Practice Address - Street 1:5721 USA DRIVE NORTH
Practice Address - Street 2:HAHN 1119
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-0002
Practice Address - Country:US
Practice Address - Phone:251-445-9378
Practice Address - Fax:251-445-9377
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1234A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist