Provider Demographics
NPI:1174167654
Name:MOULDIN, CHAQUOYA
Entity type:Individual
Prefix:
First Name:CHAQUOYA
Middle Name:
Last Name:MOULDIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8655 JONES RD APT 1101
Mailing Address - Street 2:
Mailing Address - City:JERSEY VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5113
Mailing Address - Country:US
Mailing Address - Phone:346-277-8047
Mailing Address - Fax:
Practice Address - Street 1:8655 JONES RD APT 1101
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77065-5113
Practice Address - Country:US
Practice Address - Phone:346-277-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX412592355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant