Provider Demographics
NPI:1124143391
Name:MOSE, JANYCE KAY (MA, CCC-A)
Entity type:Individual
Prefix:
First Name:JANYCE
Middle Name:KAY
Last Name:MOSE
Suffix:
Gender:F
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 EASTERLY PKWY
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6300
Mailing Address - Country:US
Mailing Address - Phone:814-867-4327
Mailing Address - Fax:814-867-4066
Practice Address - Street 1:233 EASTERLY PKWY
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6300
Practice Address - Country:US
Practice Address - Phone:814-867-4327
Practice Address - Fax:814-867-4066
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000847L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50049461OtherCAPITAL BC
PW06324OtherHEALTHAMERICA