Provider Demographics
NPI:1306850003
Name:MOORE, ALICIA (AU)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:AU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:985-646-4400
Mailing Address - Fax:
Practice Address - Street 1:2050 GAUSE BLVD E STE 200
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5425
Practice Address - Country:US
Practice Address - Phone:985-646-4400
Practice Address - Fax:985-646-4408
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2848237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1169307Medicaid
LA1169307Medicaid