Healthcare Provider Details

I. General information

NPI: 1306169404
Provider Name (Legal Business Name): KATIE MOORE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE MOORE

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 E OAKLEY PARK RD STE 101
COMMERCE TOWNSHIP MI
48390-1569
US

IV. Provider business mailing address

PO BOX 412031
BOSTON MA
02241-2031
US

V. Phone/Fax

Practice location:
  • Phone: 732-965-8475
  • Fax: 732-719-7156
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: