Provider Demographics
NPI:1114364304
Name:DAWN M. MOORE MA, CCC-SLP, INC.
Entity Type:Organization
Organization Name:DAWN M. MOORE MA, CCC-SLP, INC.
Other - Org Name:EXPRESSIONS, SPEECH, LANGUAGE, & MYOFUNCTIONAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:CLINSCD, CCC-SLP, C
Authorized Official - Phone:336-380-6966
Mailing Address - Street 1:3102 S CHURCH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215
Mailing Address - Country:US
Mailing Address - Phone:336-350-9263
Mailing Address - Fax:336-350-9264
Practice Address - Street 1:3102 S CHURCH ST STE 102
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215
Practice Address - Country:US
Practice Address - Phone:336-350-9263
Practice Address - Fax:336-350-9264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4940235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7411655Medicaid