Provider Demographics
NPI:1376118331
Name:MOORE, ERIN (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12608 FALCONBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3411
Mailing Address - Country:US
Mailing Address - Phone:301-335-1154
Mailing Address - Fax:
Practice Address - Street 1:4409 E WEST HWY
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1058
Practice Address - Country:US
Practice Address - Phone:301-699-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09719235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist