Individual
BIANCA SADE MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ST
Contact information
Practice address
12857 ARBOR DR, OLIVE BRANCH, MS 38654-9546
(901) 857-6566
Mailing address
12857 ARBOR DR, OLIVE BRANCH, MS 38654-9546
(901) 857-6566
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
3847
MS
235Z00000X
Speech-Language Pathologist
Primary
4731
TN
Other
Enumeration date
06/11/2014
Last updated
10/11/2022
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