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General NPI Number Information
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NPI Number | 1114458528
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Entity Type | Individual
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Provider Name | CANDACE MOORE SLP-CCC
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Gender | Female
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Dates
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Enumeration Date | 03/27/2017
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Last Update Date | 03/27/2017
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Provider Practice Location Address
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Address Line | 6003 MASONDALE RD
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City | ALEXANDRIA
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State | VA
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Zip | 22315-5596
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Country | US
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Telephone | 304-488-4372
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Fax |
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Provider Business Mailing Address
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Address Line | 816 N OAKLAND ST APT 504
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City | ARLINGTON
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State | VA
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Zip | 22203-5857
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Country | US
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Telephone | 252-327-2814
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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 | 2202008172
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License Number State | VA
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