Provider Demographics
NPI:1861515462
Name:MOYER, JOANNE JEANETTE (MSCCC,SLP)
Entity type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:JEANETTE
Last Name:MOYER
Suffix:
Gender:F
Credentials:MSCCC,SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CHAMBERLAINE AVE
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-8652
Mailing Address - Country:US
Mailing Address - Phone:570-628-2488
Mailing Address - Fax:
Practice Address - Street 1:401UNIVERSTIY DRIVE
Practice Address - Street 2:REST HAVEN
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972
Practice Address - Country:US
Practice Address - Phone:570-385-0331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL000643L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist