Provider Demographics
NPI:1558589259
Name:MOORE, HEATHER BAIR (CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:BAIR
Last Name:MOORE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:HEATHE
Other - Middle Name:LAURA
Other - Last Name:WEINTRAUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3524 SE SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333-3208
Mailing Address - Country:US
Mailing Address - Phone:541-231-8799
Mailing Address - Fax:
Practice Address - Street 1:111 N 20TH ST
Practice Address - Street 2:
Practice Address - City:PHILOMATH
Practice Address - State:OR
Practice Address - Zip Code:97370-9621
Practice Address - Country:US
Practice Address - Phone:541-368-4313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12896235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist