Provider Demographics
NPI:1598907230
Name:MOSS, SHEILA MARLENE (MACCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:MARLENE
Last Name:MOSS
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 MARGATE TER
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3449
Mailing Address - Country:US
Mailing Address - Phone:847-940-9114
Mailing Address - Fax:847-940-9214
Practice Address - Street 1:342 MARGATE TER
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-3449
Practice Address - Country:US
Practice Address - Phone:847-940-9114
Practice Address - Fax:847-940-9214
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-000423235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist