Individual
MS. TATYANA VIVIENNA MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP-CCC
Contact information
Practice address
106 BLOOMSBURY AVE, CATONSVILLE, MD 21228-5249
(443) 809-0800
Mailing address
224 SMARTY JONES TER, HVRE DE GRACE, MD 21078-2300
(443) 987-2536
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
02586
MD
Other
Enumeration date
08/30/2022
Last updated
08/30/2022
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