Individual
LISA G MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
301 S GALLAHER VIEW RD STE 105, KNOXVILLE, TN 37919-5302
(615) 614-8833
Mailing address
90 HOWARD DR, SHELBYVILLE, KY 40065-8138
(502) 633-1007
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4713
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1528933
—
TN
Enumeration date
06/28/2012
Last updated
02/28/2022
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