Provider Demographics
NPI:1710154976
Name:MOSES, VALERIE E (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:E
Last Name:MOSES
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:MOBLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:644 BULTMAN DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2550
Mailing Address - Country:US
Mailing Address - Phone:803-774-0228
Mailing Address - Fax:803-774-0229
Practice Address - Street 1:644 BULTMAN DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2550
Practice Address - Country:US
Practice Address - Phone:803-774-0228
Practice Address - Fax:803-774-0229
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0615Medicaid