Provider Demographics
NPI:1447420039
Name:MOSER, MEGHAN R (SLP)
Entity Type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:R
Last Name:MOSER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2421
Mailing Address - Country:US
Mailing Address - Phone:847-480-8890
Mailing Address - Fax:847-480-8897
Practice Address - Street 1:650 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2421
Practice Address - Country:US
Practice Address - Phone:847-480-8890
Practice Address - Fax:847-480-8897
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist