Provider Demographics
NPI:1700940848
Name:MOSS, STEPHANIE E (MA, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:E
Last Name:MOSS
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 1:870 SHASTA AVE
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442-1933
Mailing Address - Country:US
Mailing Address - Phone:805-772-3277
Mailing Address - Fax:805-772-3831
Practice Address - Street 1:870 SHASTA AVE
Practice Address - Street 2:
Practice Address - City:MORRO BAY
Practice Address - State:CA
Practice Address - Zip Code:93442-1933
Practice Address - Country:US
Practice Address - Phone:805-772-3277
Practice Address - Fax:805-772-3831
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU406231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR13990Medicare UPIN