Provider Demographics
NPI:1780784504
Name:MOGGIO, LINDA JANE (MA, CCC-A)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JANE
Last Name:MOGGIO
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 1:44 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-2510
Mailing Address - Country:US
Mailing Address - Phone:914-949-1965
Mailing Address - Fax:
Practice Address - Street 1:44 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-2510
Practice Address - Country:US
Practice Address - Phone:914-949-1965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001668231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS80324Medicare UPIN