Provider Demographics
NPI:1669656328
Name:MOORE, CAROLINE ELIZABETH (MED, MA CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:MOORE
Suffix:
Gender:F
Credentials:MED, MA CCC/SLP
Other - Prefix:
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Mailing Address - Street 1:1005 RAIL WAY
Mailing Address - Street 2:
Mailing Address - City:COSBY
Mailing Address - State:TN
Mailing Address - Zip Code:37722-3414
Mailing Address - Country:US
Mailing Address - Phone:423-608-2885
Mailing Address - Fax:865-761-4045
Practice Address - Street 1:642 COSBY HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3418
Practice Address - Country:US
Practice Address - Phone:423-608-2885
Practice Address - Fax:865-761-4045
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13018235Z00000X
OHSP-6113235Z00000X
KY280800235Z00000X
TN8570235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist