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NPI Code Detail

MEDICARE: MRS. KATHRYN MOORE M.S., CCC-SLP

MEDICARE: MRS. KATHRYN MOORE M.S., CCC-SLP
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
1235Z00000XSpeech-Language Pathologist2284OK

General Provider Information

NPI Number : 1952704389
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KATHRYN MOORE M.S., CCC-SLP
Provider Business Mailing Address
First Line : 3144 E 47TH ST
Second Line :
City : TULSA
State : OK
Zip : 74105-5307
Country : US
Telephone Number : 918-619-6143
Fax Number :
Provider Business Practice Location Address
First Line : 6715 E 41ST ST
Second Line :
City : TULSA
State : OK
Zip : 74145-4520
Country : US
Telephone Number : 405-740-6825
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2014
Last Update Date : 09/30/2014

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Directions to “ MRS. KATHRYN MOORE M.S., CCC-SLP” Practice Location

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