Provider Demographics
NPI:1013465608
Name:MOON, ERIN AYEN (MS ED, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:ERIN
Middle Name:AYEN
Last Name:MOON
Suffix:
Gender:F
Credentials:MS ED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:GOUVERNEUR
Mailing Address - State:NY
Mailing Address - Zip Code:13642-1328
Mailing Address - Country:US
Mailing Address - Phone:315-287-3200
Mailing Address - Fax:315-287-7222
Practice Address - Street 1:111 GLEASON ST
Practice Address - Street 2:
Practice Address - City:GOUVERNEUR
Practice Address - State:NY
Practice Address - Zip Code:13642-1217
Practice Address - Country:US
Practice Address - Phone:315-287-2260
Practice Address - Fax:315-287-2410
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist