Provider Demographics
NPI:1275689366
Name:MOORE, KARLA ANNETTE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:KARLA
Middle Name:ANNETTE
Last Name:MOORE
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 1:100 EAST MISSOURI
Mailing Address - Street 2:P.O. BOX 275
Mailing Address - City:MELROSE
Mailing Address - State:NM
Mailing Address - Zip Code:88124
Mailing Address - Country:US
Mailing Address - Phone:505-253-4266
Mailing Address - Fax:505-253-4291
Practice Address - Street 1:100 EAST MISSOURI
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:NM
Practice Address - Zip Code:88124
Practice Address - Country:US
Practice Address - Phone:505-253-4266
Practice Address - Fax:505-253-4291
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3260235Z00000X
TX100576235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist