Provider Demographics
NPI:1508816711
Name:O GARA-MOE, CHARLENE L (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:L
Last Name:O GARA-MOE
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 SPRING CREEK PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SPRING CREEK
Mailing Address - State:NV
Mailing Address - Zip Code:89815
Mailing Address - Country:US
Mailing Address - Phone:775-753-6806
Mailing Address - Fax:
Practice Address - Street 1:215 BLUFFS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801
Practice Address - Country:US
Practice Address - Phone:775-738-2925
Practice Address - Fax:775-738-7395
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP1069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist