MEDICARE: NATALIE ANN MOORE

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	3670	KS

General Provider Information

NPI Number	:	1639757495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE ANN MOORE

Provider Business Mailing Address
First Line	:	2924 HARRISON AVE
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66047-3056
Country	:	US
Telephone Number	:	913-484-4364
Fax Number	:

Provider Business Practice Location Address
First Line	:	1621 BOB WHITE DR
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66047-9305
Country	:	US
Telephone Number	:	785-766-3217
Fax Number	:

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

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	03/31/2021

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Directions to “ NATALIE ANN MOORE ” Practice Location

Language	Start Address	Practice Location

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