Healthcare Provider Details

I. General information

NPI: 1952247439
Provider Name (Legal Business Name): SARAH THERESA MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 E GARLAND AVE
FRESNO CA
93726-6102
US

IV. Provider business mailing address

6994 E RAMONA WAY
FRESNO CA
93727-0903
US

V. Phone/Fax

Practice location:
  • Phone: 559-248-7475
  • Fax:
Mailing address:
  • Phone: 559-457-3220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP16313
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: