NPIMap

Individual provider Active NPI

David G Moehn, MS, CCC-SLP

  • Speech-Language Pathologist
  • Fond Du Lac, WI
National Provider Identifier
1558604165
Registry record updated Apr 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
3754-154 Issued in WI
Practice address
845 S Main St
Suite 120
Fond Du Lac, WI 54935-6174
Phone
(920) 322-0447
NPI assigned
Apr 2, 2013
Last updated
Apr 2, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 3754-154 WI Primary

Addresses

Primary practice location

845 S Main St
Suite 120
Fond Du Lac, WI 54935-6174

Mailing address

845 S Main St
Suite 120
Fond Du Lac, WI 54935-6174

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
3754-154WIMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Taylored Rehab, LLC Speech-Language Pathologist Past Accepting new patients
Rehab Arisces Home Health Services Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364860800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364860800000",
    "number": "1558604165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 S MAIN ST",
            "address_2": "SUITE 120",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549356174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 S MAIN ST",
            "address_2": "SUITE 120",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549356174",
            "telephone_number": "920-322-0447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOEHN",
        "first_name": "DAVID",
        "middle_name": "G",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-02",
        "last_updated": "2013-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "3754-154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fond Du Lac, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.