Individual
JENNA MOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A. C.C.C.-SLP
Contact information
Practice address
250 MOUNT LEBANON BLVD, SUITE 411, PITTSBURGH, PA 15234-1252
(412) 563-2434
(412) 563-7610
Mailing address
250 MOUNT LEBANON BLVD, SUITE 411, PITTSBURGH, PA 15234-1252
(412) 563-2434
(412) 563-7610
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL010014
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1982671467
GROUP NPI
—
01
—
251553131
GROUP TAX ID
—
01
—
574931
GROUP HIGHMARK PROVIDER ID
—
Enumeration date
12/17/2010
Last updated
12/17/2010
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