Provider Demographics
NPI:1659889988
Name:MOORE, SCARLETT SMITH
Entity Type:Individual
Prefix:
First Name:SCARLETT
Middle Name:SMITH
Last Name:MOORE
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:PO BOX 1849
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558-1849
Mailing Address - Country:US
Mailing Address - Phone:434-476-2171
Mailing Address - Fax:
Practice Address - Street 1:7091 HUELL MATTHEWS HWY
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:VA
Practice Address - Zip Code:24520-3091
Practice Address - Country:US
Practice Address - Phone:434-517-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist