Provider Demographics
NPI:1821038324
Name:MOSHER, PAMELA ANN (MS-CCCA)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:MOSHER
Suffix:
Gender:F
Credentials:MS-CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3807
Mailing Address - Country:US
Mailing Address - Phone:816-313-2800
Mailing Address - Fax:816-792-9819
Practice Address - Street 1:501 1ST CAPITOL DR
Practice Address - Street 2:SUITE 8
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2768
Practice Address - Country:US
Practice Address - Phone:636-940-9119
Practice Address - Fax:636-940-9789
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108339231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO168300002Medicare UPIN