Provider Demographics
NPI:1801034160
Name:MOSLEY, CARINA YVETTE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CARINA
Middle Name:YVETTE
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5130 S FLORIDA AVE STE 411
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2539
Mailing Address - Country:US
Mailing Address - Phone:863-732-9955
Mailing Address - Fax:863-210-2157
Practice Address - Street 1:5130 S FLORIDA AVE STE 411
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2539
Practice Address - Country:US
Practice Address - Phone:863-732-9955
Practice Address - Fax:863-210-2157
Is Sole Proprietor?:No
Enumeration Date:2009-01-25
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9299235Z00000X, 235Z00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist