MEDICARE: AMY C MOORE MS, 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	2071	AL

General Provider Information

NPI Number	:	1447492293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY C MOORE MS, CCC-SLP

Provider Business Mailing Address
First Line	:	152 BELLE MEADE DR
Second Line	:
City	:	BREWTON
State	:	AL
Zip	:	36426-4006
Country	:	US
Telephone Number	:	251-363-6213
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 FORREST AVE
Second Line	:
City	:	EAST BREWTON
State	:	AL
Zip	:	36426-2622
Country	:	US
Telephone Number	:	251-363-6213
Fax Number	:

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

Provider Enumeration Date	:	03/25/2009
Last Update Date	:	08/23/2021

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