Provider Demographics
NPI:1144492968
Name:MOORE, CINDY KAY (MA)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:KAY
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:KAY
Other - Last Name:LIBBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2550 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4432
Mailing Address - Country:US
Mailing Address - Phone:814-833-9533
Mailing Address - Fax:814-833-1621
Practice Address - Street 1:2550 W 8TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4432
Practice Address - Country:US
Practice Address - Phone:814-833-9533
Practice Address - Fax:814-833-1621
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006603231H00000X
MI1601000772231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4240382Medicare PIN