Provider Demographics
NPI:1831405216
Name:MOSS, MEGAN H (SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:H
Last Name:MOSS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BUSINESS HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:MONROE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63456-1351
Mailing Address - Country:US
Mailing Address - Phone:573-735-4631
Mailing Address - Fax:573-735-2413
Practice Address - Street 1:401 BUSINESS HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:MONROE CITY
Practice Address - State:MO
Practice Address - Zip Code:63456-1351
Practice Address - Country:US
Practice Address - Phone:573-735-4631
Practice Address - Fax:573-735-2413
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010023070235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist