Provider Demographics
NPI:1417234741
Name:MOSS, VICKI (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:
Last Name:MOSS
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 1:9740 S MCCARRAN BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-9204
Mailing Address - Country:US
Mailing Address - Phone:775-848-8906
Mailing Address - Fax:775-324-2955
Practice Address - Street 1:3189 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-2201
Practice Address - Country:US
Practice Address - Phone:775-848-8906
Practice Address - Fax:775-324-2955
Is Sole Proprietor?:No
Enumeration Date:2011-11-15
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-253235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist