Provider Demographics
NPI:1558692905
Name:MORA, JANET EUGENIE
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:EUGENIE
Last Name:MORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18639 PERKINS RD LOT 14
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3277
Mailing Address - Country:US
Mailing Address - Phone:225-810-1792
Mailing Address - Fax:
Practice Address - Street 1:11975 SEAWAY RD STE A226
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-6250
Practice Address - Country:US
Practice Address - Phone:228-896-2824
Practice Address - Fax:228-896-2825
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist