Provider Demographics
NPI:1558873125
Name:MOSES, JAN JEANNINE (MS/CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:JEANNINE
Last Name:MOSES
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:MS
Other - First Name:JAN
Other - Middle Name:JEANNINE
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS/CCC-SLP
Mailing Address - Street 1:305 NE LOOP 820 STE 200
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7211
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:9900 N CENTRAL EXPY STE 370
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4395
Practice Address - Country:US
Practice Address - Phone:469-364-8680
Practice Address - Fax:855-275-2406
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14469235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist