Provider Demographics
NPI:1184769622
Name:MOORE, MARY CATHERINE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CATHERINE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1441 WILLSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9098
Mailing Address - Country:US
Mailing Address - Phone:317-859-9696
Mailing Address - Fax:
Practice Address - Street 1:3000 S STATE ROAD 135
Practice Address - Street 2:SUITE 110
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9607
Practice Address - Country:US
Practice Address - Phone:317-535-4075
Practice Address - Fax:317-535-4076
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004174A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist