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General NPI Number Information
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NPI Number | 1336956853
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Entity Type | Individual
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Provider Name | MARGRET MOORE MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/17/2024
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 2080 S FRONTAGE RD STE 108
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City | VICKSBURG
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State | MS
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Zip | 39180-5882
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Country | US
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Telephone | 601-883-1983
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Fax | 601-883-1938
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Provider Business Mailing Address
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Address Line | 1901A MISSION 66
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City | VICKSBURG
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State | MS
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Zip | 39180-3711
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Country | US
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Telephone | 601-638-5518
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Fax | 601-638-7122
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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 | S-5050
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License Number State | MS
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