MEDICARE: JORDAN DRU MOORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1356952337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN DRU MOORE

Provider Business Mailing Address
First Line	:	2709 FRANCISCO ST UNIT B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78702-3920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2709 FRANCISCO ST UNIT B
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78702-3920
Country	:	US
Telephone Number	:	361-816-5458
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2020
Last Update Date	:	08/12/2020

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Directions to “ JORDAN DRU MOORE ” Practice Location

Language	Start Address	Practice Location

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