Provider Demographics
NPI:1093938110
Name:MOSES, TAMMY (MS, CFY-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:
Last Name:MOSES
Suffix:
Gender:F
Credentials:MS, CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23814 N 42ND DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5557
Mailing Address - Country:US
Mailing Address - Phone:623-203-0070
Mailing Address - Fax:
Practice Address - Street 1:1941 E WESCOTT DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-2434
Practice Address - Country:US
Practice Address - Phone:602-441-5975
Practice Address - Fax:602-485-8859
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP5228235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist