Provider Demographics
NPI:1699010207
Name:MOON HEARING SERVICES LLC
Entity Type:Organization
Organization Name:MOON HEARING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALYSIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, CCC-A
Authorized Official - Phone:781-573-3277
Mailing Address - Street 1:23 WARREN AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-4979
Mailing Address - Country:US
Mailing Address - Phone:781-573-3277
Mailing Address - Fax:781-933-0478
Practice Address - Street 1:23 WARREN AVE STE 130
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-4979
Practice Address - Country:US
Practice Address - Phone:781-573-3277
Practice Address - Fax:781-933-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA744231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty