Provider Demographics
NPI:1770812240
Name:MOSER, CLAIRE BLACKWELL (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:BLACKWELL
Last Name:MOSER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1223
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-1223
Mailing Address - Country:US
Mailing Address - Phone:865-579-2293
Mailing Address - Fax:865-579-2295
Practice Address - Street 1:10721 CHAPMAN HWY
Practice Address - Street 2:SUITE 22
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4765
Practice Address - Country:US
Practice Address - Phone:865-579-2293
Practice Address - Fax:865-579-2295
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-13
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4199235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist