Provider Demographics
NPI:1669656328
Name:MOORE, CAROLINE ELIZABETH (MED, MA CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:MOORE
Suffix:
Gender:F
Credentials:MED, MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 RAIL WAY
Mailing Address - Street 2:
Mailing Address - City:COSBY
Mailing Address - State:TN
Mailing Address - Zip Code:37722-3466
Mailing Address - Country:US
Mailing Address - Phone:833-443-7200
Mailing Address - Fax:
Practice Address - Street 1:1005 RAIL WAY
Practice Address - Street 2:
Practice Address - City:COSBY
Practice Address - State:TN
Practice Address - Zip Code:37722-3466
Practice Address - Country:US
Practice Address - Phone:833-443-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-6113235Z00000X
KY280800235Z00000X
TN8570235Z00000X
FLSA13018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist