Provider Demographics
NPI:1255571659
Name:MOSS, ELIZABETH MCCOAN (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MCCOAN
Last Name:MOSS
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:MCCOAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC/SLP
Mailing Address - Street 1:13 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-1805
Mailing Address - Country:US
Mailing Address - Phone:207-315-5694
Mailing Address - Fax:
Practice Address - Street 1:91 CAMDEN ST STE 108
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2430
Practice Address - Country:US
Practice Address - Phone:207-542-4365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3632235Z00000X
MESP 1322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist