Provider Demographics
NPI:1902673247
Name:MOORE SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:MOORE SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLAN
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:912-429-3781
Mailing Address - Street 1:966 CLEARY RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLET
Mailing Address - State:GA
Mailing Address - Zip Code:30415-5166
Mailing Address - Country:US
Mailing Address - Phone:912-429-3781
Mailing Address - Fax:
Practice Address - Street 1:966 CLEARY RD
Practice Address - Street 2:
Practice Address - City:BROOKLET
Practice Address - State:GA
Practice Address - Zip Code:30415-5166
Practice Address - Country:US
Practice Address - Phone:912-429-3781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty