Provider Demographics
NPI:1497352496
Name:MOORE, KRISTINE HELEN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:HELEN
Last Name:MOORE
Suffix:
Gender:F
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 1:6300 PINEHURST RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2534
Mailing Address - Country:US
Mailing Address - Phone:443-846-3638
Mailing Address - Fax:
Practice Address - Street 1:6300 PINEHURST RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2534
Practice Address - Country:US
Practice Address - Phone:443-846-3638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04776235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist