Provider Demographics
NPI:1053093377
Name:MOSS SLP THERAPY LLC
Entity type:Organization
Organization Name:MOSS SLP THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, CBIS
Authorized Official - Phone:817-727-3226
Mailing Address - Street 1:11080 LOTHMORE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-3873
Mailing Address - Country:US
Mailing Address - Phone:817-727-3226
Mailing Address - Fax:
Practice Address - Street 1:11080 LOTHMORE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-3873
Practice Address - Country:US
Practice Address - Phone:817-727-3226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty