Provider Demographics
NPI:1093855579
Name:LAURA MOSHE
Entity Type:Organization
Organization Name:LAURA MOSHE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC
Authorized Official - Phone:561-784-4672
Mailing Address - Street 1:14572 STIRRUP LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8217
Mailing Address - Country:US
Mailing Address - Phone:561-784-4672
Mailing Address - Fax:561-784-4672
Practice Address - Street 1:14572 STIRRUP LN
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8217
Practice Address - Country:US
Practice Address - Phone:561-784-4672
Practice Address - Fax:561-784-4672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4818235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8853797Medicaid