Provider Demographics
NPI:1669199220
Name:MOORE, MELODIE ELISABETH
Entity type:Individual
Prefix:
First Name:MELODIE
Middle Name:ELISABETH
Last Name:MOORE
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 1:3326 ASPEN GROVE DR STE 312
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-4847
Mailing Address - Country:US
Mailing Address - Phone:615-651-4833
Mailing Address - Fax:615-845-5631
Practice Address - Street 1:3326 ASPEN GROVE DR STE 312
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-4847
Practice Address - Country:US
Practice Address - Phone:615-651-4833
Practice Address - Fax:615-845-5631
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7737235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1215409776OtherN/A