Provider Demographics
NPI:1215191721
Name:MOFFITT, KWYN L (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:KWYN
Middle Name:L
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7100 N HIGH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2316
Mailing Address - Country:US
Mailing Address - Phone:614-505-7330
Mailing Address - Fax:614-388-5808
Practice Address - Street 1:7100 N HIGH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2316
Practice Address - Country:US
Practice Address - Phone:614-505-7330
Practice Address - Fax:614-388-5808
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.5148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist