Provider Demographics
NPI:1295867604
Name:MOORE, MARY ANN (MA CCC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12337 JONES RD
Mailing Address - Street 2:SUITE 426
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4800
Mailing Address - Country:US
Mailing Address - Phone:281-894-6009
Mailing Address - Fax:
Practice Address - Street 1:12337 JONES RD
Practice Address - Street 2:SUITE 426
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4800
Practice Address - Country:US
Practice Address - Phone:281-894-6009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11640235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist