Provider Demographics
NPI:1447549852
Name:MOCZULSKI, AMY JO (MA,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JO
Last Name:MOCZULSKI
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:JO
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 BARBER PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1863
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:814-874-5505
Practice Address - Street 1:100 BARBER PL
Practice Address - Street 2:CONTRACTING BOX 92
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1863
Practice Address - Country:US
Practice Address - Phone:814-453-7661
Practice Address - Fax:814-874-5505
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010005235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist