Provider Demographics
NPI:1649573890
Name:HART, MORIAH JANE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MORIAH
Middle Name:JANE
Last Name:HART
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:MORIAH
Other - Middle Name:JANE
Other - Last Name:SANTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1424 W GENEVA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-3436
Mailing Address - Country:US
Mailing Address - Phone:928-300-7194
Mailing Address - Fax:
Practice Address - Street 1:1424 W GENEVA DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-3436
Practice Address - Country:US
Practice Address - Phone:928-300-7194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP7059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZSLP7059OtherASHA