Provider Demographics
NPI:1477814598
Name:MOON, AMBER RASHEL (MSCCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:RASHEL
Last Name:MOON
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:RASHEL
Other - Last Name:CROUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSCCC-SLP
Mailing Address - Street 1:1964 E CALLE MONTE VIS
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2562
Mailing Address - Country:US
Mailing Address - Phone:480-296-8916
Mailing Address - Fax:
Practice Address - Street 1:815 E WARNER RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225
Practice Address - Country:US
Practice Address - Phone:480-963-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA77562355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant