Provider Demographics
NPI:1518330562
Name:MOORE, JO ACREE (AUD)
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:ACREE
Last Name:MOORE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:JO
Other - Middle Name:NELL
Other - Last Name:ACREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2901 N GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-1748
Mailing Address - Country:US
Mailing Address - Phone:405-519-4846
Mailing Address - Fax:
Practice Address - Street 1:3650 W ROCK CREEK RD STE 110B
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2202
Practice Address - Country:US
Practice Address - Phone:405-364-2684
Practice Address - Fax:405-607-3530
Is Sole Proprietor?:No
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4376231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist