Provider Demographics
NPI:1073170387
Name:MOORE, JOSEPH H (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:H
Last Name:MOORE
Suffix:
Gender:M
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 1:530 MARTINSVILLE DR
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5102
Mailing Address - Country:US
Mailing Address - Phone:843-957-8486
Mailing Address - Fax:
Practice Address - Street 1:1102 S EBENEZER RD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-8009
Practice Address - Country:US
Practice Address - Phone:843-673-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3774235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist