Provider Demographics
NPI:1649757204
Name:MOORE, AMITHYSE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMITHYSE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1101 S CAPITOL OF TEXAS HIGHWAY
Mailing Address - Street 2:BUILDING G-200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5927
Mailing Address - Country:US
Mailing Address - Phone:800-967-4667
Mailing Address - Fax:
Practice Address - Street 1:20400 SARATOGA LOS GATOS RD
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5927
Practice Address - Country:US
Practice Address - Phone:408-741-2950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA27325OtherSPEECH THERAPY