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General NPI Number Information
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NPI Number | 1023996741
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Entity Type | Individual
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Provider Name | MATTHEW WAYNE MOOBERRY MA SLP
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Gender | Male
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 1371 HECLA DR STE D130
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City | LOUISVILLE
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State | CO
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Zip | 80027-2318
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Country | US
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Telephone | 303-963-5582
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Fax |
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Provider Business Mailing Address
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Address Line | 10656 RING AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91737-4416
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Country | US
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Telephone | 909-731-7965
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | PSLP.0001474
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License Number State | CO
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