Provider Demographics
NPI:1285757336
Name:MOSS, JAIME ELIZABETH (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:ELIZABETH
Last Name:MOSS
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:ELIZABETH
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:9330 LBJ FWY
Mailing Address - Street 2:SUITE 790
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3436
Mailing Address - Country:US
Mailing Address - Phone:214-830-2533
Mailing Address - Fax:
Practice Address - Street 1:11020 CANARY ISLAND CT
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-8203
Practice Address - Country:US
Practice Address - Phone:214-830-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7231235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891003100Medicaid