Provider Demographics
NPI:1437609013
Name:MOATES, RONNY STEVEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RONNY
Middle Name:STEVEN
Last Name:MOATES
Suffix:
Gender:M
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 1:634 EDDY AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59812-1851
Mailing Address - Country:US
Mailing Address - Phone:406-243-2377
Mailing Address - Fax:406-243-2362
Practice Address - Street 1:634 EDDY AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-1851
Practice Address - Country:US
Practice Address - Phone:406-243-2377
Practice Address - Fax:406-243-2362
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTSLP-SP-LIC-5926235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist