1124143391 NPI number — JANYCE KAY MOSE M.A., CCC-A

Table of content: JANYCE KAY MOSE M.A., CCC-A (NPI 1124143391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124143391 NPI number — JANYCE KAY MOSE M.A., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSE
Provider First Name:
JANYCE
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124143391
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
233 EASTERLY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATE COLLEGE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16801-6300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-867-4327
Provider Business Mailing Address Fax Number:
814-867-4066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
233 EASTERLY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATE COLLEGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16801-6300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-867-4327
Provider Business Practice Location Address Fax Number:
814-867-4066
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  AT000847L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50049461 . This is a "CAPITAL BC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 06324 . This is a "HEALTHAMERICA" identifier , issued by the state of ( PW ) . This identifiers is of the category "OTHER".




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