Provider Demographics
NPI:1427351196
Name:MOE, JENNA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MOE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:HAROLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 MOUNT LEBANON BLVD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15234-1252
Mailing Address - Country:US
Mailing Address - Phone:412-563-2434
Mailing Address - Fax:412-563-7610
Practice Address - Street 1:250 MOUNT LEBANON BLVD
Practice Address - Street 2:SUITE 411
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15234-1252
Practice Address - Country:US
Practice Address - Phone:412-563-2434
Practice Address - Fax:412-563-7610
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010014235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
574931OtherGROUP HIGHMARK PROVIDER ID
1982671467OtherGROUP NPI
251553131OtherGROUP TAX ID
1982671467OtherGROUP NPI