Provider Demographics
NPI:1518211572
Name:MOORE, CHARLI MICHELLE (SLP)
Entity Type:Individual
Prefix:
First Name:CHARLI
Middle Name:MICHELLE
Last Name:MOORE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 E. MOREHEAD ST.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-2767
Mailing Address - Country:US
Mailing Address - Phone:704-523-8027
Mailing Address - Fax:704-523-8031
Practice Address - Street 1:817 E. MOREHEAD ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-2767
Practice Address - Country:US
Practice Address - Phone:704-523-8027
Practice Address - Fax:704-523-8031
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist