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NPI Code Detail

MEDICARE: SADIE MOORE CCC-SLP

MEDICARE: SADIE MOORE 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
1235Z00000XSpeech-Language PathologistMN

General Provider Information

NPI Number : 1760859037
Entity Type Code : Individual
Provider Name (Legal Business Name) : SADIE MOORE CCC-SLP
Provider Business Mailing Address
First Line : 31113 SPRING LOOP
Second Line :
City : BREEZY POINT
State : MN
Zip : 56472-4023
Country : US
Telephone Number : 719-323-0196
Fax Number :
Provider Business Practice Location Address
First Line : 804 OAK ST
Second Line :
City : BRAINERD
State : MN
Zip : 56401-3755
Country : US
Telephone Number : 218-454-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2015
Last Update Date : 04/12/2026

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Directions to “ SADIE MOORE CCC-SLP” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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