MEDICARE: MRS. SUSIE ROBERTS MOYER CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP003326	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376586842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSIE ROBERTS MOYER CCC-SLP

Provider Business Mailing Address
First Line	:	2440 WATSON SPRINGS RD
Second Line	:
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-3622
Country	:	US
Telephone Number	:	706-255-1039
Fax Number	:	706-369-4492

Provider Business Practice Location Address
First Line	:	2440 WATSON SPRINGS RD
Second Line	:
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-3622
Country	:	US
Telephone Number	:	706-255-1039
Fax Number	:	706-369-4492

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	03/31/2021

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Directions to “ MRS. SUSIE ROBERTS MOYER CCC-SLP” Practice Location

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