Provider Demographics
NPI:1073278750
Name:MOODY, MICHAYLA H (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MICHAYLA
Middle Name:H
Last Name:MOODY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-3102
Mailing Address - Country:US
Mailing Address - Phone:229-292-1945
Mailing Address - Fax:888-450-0379
Practice Address - Street 1:4808 SPRINGBROOK DR
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-3102
Practice Address - Country:US
Practice Address - Phone:229-292-1945
Practice Address - Fax:888-450-0379
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011290235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist