Provider Demographics
NPI:1548547722
Name:MOORE, CATHERINE R (MA CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:R
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 DURRAND OAK DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5640
Mailing Address - Country:US
Mailing Address - Phone:817-723-8736
Mailing Address - Fax:
Practice Address - Street 1:408 DURRAND OAK DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5640
Practice Address - Country:US
Practice Address - Phone:817-723-8736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18155235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist