Provider Demographics
NPI:1114369295
Name:MOSELEY, DEVIN MICHELLE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:MICHELLE
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15006 N 500TH ST
Mailing Address - Street 2:
Mailing Address - City:BROCTON
Mailing Address - State:IL
Mailing Address - Zip Code:61917-8132
Mailing Address - Country:US
Mailing Address - Phone:405-590-6094
Mailing Address - Fax:
Practice Address - Street 1:310 S EADS AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:IL
Practice Address - Zip Code:61944-1938
Practice Address - Country:US
Practice Address - Phone:217-463-1625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.002601235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist