Provider Demographics
NPI:1316235559
Name:MOON, AMY C (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:C
Last Name:MOON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 RUSSETTS CIR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-3220
Mailing Address - Country:US
Mailing Address - Phone:412-370-0446
Mailing Address - Fax:
Practice Address - Street 1:1500 OXFORD DR
Practice Address - Street 2:SUITE 10
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1823
Practice Address - Country:US
Practice Address - Phone:412-692-3448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010464235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist