Individual
TARA MOXHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA CCC-SLP
Contact information
Practice address
4400 LUMBERJACK LN, GLEN ALLEN, VA 23060-6275
(321) 952-1818
Mailing address
4400 LUMBERJACK LN, GLEN ALLEN, VA 23060-6275
(321) 952-1818
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202007194
VA
Other
Enumeration date
10/11/2013
Last updated
10/11/2013
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