Healthcare Provider Details

I. General information

NPI: 1356673784
Provider Name (Legal Business Name): ALLISON MOORE M.S. CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2010
Last Update Date: 06/09/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6502 SLIDE RD STE 204
LUBBOCK TX
79424-1311
US

IV. Provider business mailing address

6502 SLIDE RD STE 204
LUBBOCK TX
79424-1311
US

V. Phone/Fax

Practice location:
  • Phone: 806-686-0429
  • Fax: 806-300-0230
Mailing address:
  • Phone: 806-686-0429
  • Fax: 806-300-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number104040
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: