Ryan Nicole Moe, M.A., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146011309 Issued in IL

Practice address

501 W Ogden Ave
La Grange, IL 60525-1850

Phone

(708) 215-6670

Fax

(708) 215-6670

NPI assigned

Dec 7, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1512604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512604800000",
    "number": "1780199117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 ARLINGTON AVE",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605255809",
            "telephone_number": "708-215-6670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 W OGDEN AVE",
            "city": "LA GRANGE",
            "state": "IL",
            "postal_code": "605251850",
            "telephone_number": "708-215-6670",
            "fax_number": "708-215-6670"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOE",
        "first_name": "RYAN",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-07",
        "last_updated": "2017-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146011309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in La Grange, IL
• Providers in La Grange, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2017; 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.