MEDICARE: MALIA 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	60631049	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60631049	OTHER	WA	WASHINGTON STATE DEPT OF HEALTH

General Provider Information

NPI Number	:	1962902460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALIA MOORE

Provider Business Mailing Address
First Line	:	1037 MOUNTAIN CIR
Second Line	:
City	:	OAK HARBOR
State	:	WA
Zip	:	98277-4147
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 27TH ST
Second Line	:
City	:	ANACORTES
State	:	WA
Zip	:	98221-2710
Country	:	US
Telephone Number	:	360-293-3174
Fax Number	:

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

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	02/20/2018

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Directions to “ MALIA MOORE ” Practice Location

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