Individual
MRS. SANDRA RENEE MOOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS/CCC-SLP
Contact information
Practice address
3540 S 43RD ST, MILWAUKEE, WI 53220-1502
(414) 328-2104
Mailing address
3456 S 35TH ST, MILWAUKEE, WI 53215-4104
(414) 333-4680
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2681-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42586400
—
WI
Enumeration date
04/12/2008
Last updated
04/12/2008
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