Provider Demographics
NPI:1235302720
Name:MOON, ALYSIA S (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:ALYSIA
Middle Name:S
Last Name:MOON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WARREN AVE.
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-1851
Mailing Address - Country:US
Mailing Address - Phone:781-573-3277
Mailing Address - Fax:781-933-0478
Practice Address - Street 1:23 WARREN AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-7906
Practice Address - Country:US
Practice Address - Phone:781-573-3277
Practice Address - Fax:781-933-0478
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA166183231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM12237OtherMEDICARE