Provider Demographics
NPI:1003066978
Name:MOORE, DANIELLE (CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 JORDAN DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-2035
Mailing Address - Country:US
Mailing Address - Phone:404-477-9400
Mailing Address - Fax:
Practice Address - Street 1:3756 LAVISTA RD
Practice Address - Street 2:SUITE 104
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5614
Practice Address - Country:US
Practice Address - Phone:404-477-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004369235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist