Healthcare Provider Details

I. General information

NPI: 1982755120
Provider Name (Legal Business Name): KATHERINE D MOORE AU.D. CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE 3RD FLOOR AUDIOLOGY DEPARTMENT
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

6126 S 20TH ST
MILWAUKEE WI
53221-5051
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-5587
  • Fax: 414-476-4701
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number364156
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: